Anesthesiologists face specific coding challenges due to cancelled anesthesia, monitored anesthesia care, failed medical direction, invasive line placement rules, and start/stop times. Every January, new medical billing and coding guidelines and policies come into effect, including coding changes in terms of added, deleted or revised codes/descriptors. Partnering with an anesthesiology medical coding company is a practical option to maintain compliance, ensure correct coding, and submit accurate claims.
Let’s take a look at some important considerations for success with anesthesia billing and coding:
- Know the Codes: As with every medical specialty, reporting the correct anesthesia CPT codes is crucial for proper reimbursement.
CPT Codes for Anesthesia Procedures
Thorax (chest wall and shoulder girdle) 00400-00474
Spine and Spinal Cord 00600-00670
Upper Abdomen 00700-00797
Lower Abdomen 00800-00882
Pelvis (except hip) 01112-01173
Upper Leg (except knee) 01200-01274
Knee and Popliteal Area 01320-01444
Lower Leg (below knee, including ankle and foot) 01462-01522
Shoulder and Axilla 01610-01680
Upper Arm and Elbow 01710-01782
Forearm, Wrist and Hand 01810-01860
Radiological Procedure 01916-01936
Burn Excisions or Debridement 01951-01953
Other Procedure 01990-01999
CPT Codes for Bundled Services
Special anesthesia service 99100
Anesthesia with hypothermia 99116
Special anesthesia procedure 99135
Emergency anesthesia 99140
- Report Anesthesia CPT Code Modifiers Correctly: Anesthesia services should be billed with an appropriate anesthesia modifier. Modifiers provide additional information about the service or procedure. Not using modifiers correctly can result in denied claims and revenue loss. There are two broad categories of anesthesia modifiers – pricing modifiers and informational modifiers.
Pricing Modifiers are assigned based on the number of providers and their roles in the anesthesia service. Pricing modifiers must be submitted in the first position to indicate whether the service was personally performed, medically directed, or medically supervised.
AA Anesthesia Services performed personally by the anesthesiologist
AD Medical Supervision by a physician: more than 4 concurrent anesthesia procedures
QK Medical Direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QX Qualified nonphysician anesthetist service: With medical direction by a physician
QY Medical direction of one qualified nonphysician anesthetist by an anesthesiologist
QZ CRNA service: Without medical direction by a physician
Informational Modifiers are placed in the second modifier position and are critical for the billing process, though they do not directly reimbursement. For e.g. QS – Monitored anesthesia care service. (Report with anesthesia CPT codes along with actual anesthesia time). Another set of informational modifiers are those used to indicate the patient’s physical status during the anesthesia procedure, for e.g. P1 – A normal healthy patient, P2 – A patient with mild systemic disease, etc.
- Follow Billing Guidelines: When billing anesthesia services, include the following for proper reimbursement:
- Select the correct CPT and HCPCS codes
- Time – number of minutes of administration or time spent on the procedure. The start and stop time of the procedure should be documented based on payer rules.
- Assign the appropriate modifier to identify the anesthesia provider.
- Procedure anesthesia (00100-01999) codes should be reported with the appropriate physical status modifier that corresponds to the status of the patient undergoing the surgical procedure.
- If multiple surgical procedures are performed during a single anesthesia administration, report only the single anesthesia code with the highest Base Unit Value (American Society of Anesthesiologists).
- Report the appropriate qualifying circumstances codes if applicable along with the anesthesia procedures can result in higher reimbursement.
New Revenue Cycle Management Challenges for Anesthesiologists
Independent anesthesia practices are dealing with new problems brought on by the COVID-19 pandemic, according to an article in Revenue Cycle Intelligence. The report references a survey in which over 90 percent of practice respondents reported a more than 50 percent decrease in case volume since the declaration of the public health emergency and the cancelation of nearly all elective and non-emergent care.
Revenue cycle management (RCM) optimization is crucial to overcome the financial and operational challenges caused by COVID-19, the report notes, and makes several recommendations to improve the efficiency and financial health of anesthesia practices:
- Leveraging data analytics and automation
- Improving employee utilization and operating room productivity
- Automating key revenue cycle management functions, like coding, payer follow-up for claims and the generation of patient statements
- Utilizing coding processes that accurately capture services to maximize base units
In addition to these strategies, the report says that practices can outsource RCM to a third-party partner, choosing the level of integration that is most appropriate for them. Even parts of the revenue cycle can be outsourced to a third party vendor for optimal performance. Outsourcing RCM can “help practices overcome the challenges of disparate EHR and technology systems to optimize revenue cycle management without multiple, costly fixes”, the report notes.
The Bottom Line: Partnering with an experienced provider of outsourced billing services can help practitioners ensure accurate billing and coding focus on engaging patients and improving revenue.