It’s essential to stay vigilant when it comes to calculating anesthesia time units. Not properly doing so can result in delayed or denied claims, decreased revenue, and audits – which can have a negative impact on your practice’s reputation.
Take a moment to look over this guide on the basics of calculating anesthesia time units so that your claims go through smoothly and accurately.
How to Determine and Report Anesthesia Time
Anesthesia time begins the moment the provider (the anesthetist) begins preparation for the patient, whether it’s in the operating room or in another area. An important thing to note is that any time spent looking over the patient’s medical records before surgery is not considered “anesthesia time” and is not billable. Instead, this is considered preoperative evaluation, and will be calculated in the base units.
The end of anesthesia time is marked by the moment the anesthetist is no longer personally attending the patient, and the patient has been moved into post-anesthetic care.
When it comes to the logistics of how one should report anesthesia time, the appropriate unit is 15-minute increments. Each 15-minute segment of anesthesia time is reported as one unit of time. So a 45-minute procedure would be considered three units of anesthesia time.
Accuracy is essential here, since Medicare pays to a tenth of a unit. Estimations of time are not appropriate. If the procedure lasts for 63 minutes, for example, then 4.2 time units would be reported – and that time should not be rounded up or down.
How to Calculate Reimbursement
There are specific formulas used to calculate reimbursement for a procedure based on the time units calculated for anesthesia time. The formula you use depends on who administered the anesthesia.
The formula for anesthesiologists or CRNAs would be:
(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment = Allowance
The formula for anesthesia performed under medical direction would be:
[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment = Allowance for each provider
Again, accuracy is essential, as your process for calculating anesthesia time units can directly impact the overall charge, which then impacts your practice’s revenue.
What Else Should You Know About Calculating Anesthesia Time Units?
There are other considerations to be made here, too. For example, if there are interruptions in anesthesia care during a procedure, the exact times of the interruption should be recorded so that discontinuous time can be accounted for and any time that the anesthetist was not personally attending the patient will not be counted.
Additionally, most insurers will not allow for any more than one time unit for preparing patients for postoperative transfer to recovery. They also don’t allow you to bill for time that the patient is in a waiting room or another type of holding area. Patients also can’t be billed for any blood products or antibiotics that are given to them in a holding area, especially when those things could have been administered in a different part of the facility.
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