Anesthesia medical billing can be complex – even daunting – at times. Practitioners are frequently faced with the challenge of not only billing and coding effectively, but also ensuring they comply with all relevant regulations and standards from several different payors.
To get the most from your billing system, here are five tips you can follow that can ensure your practice complies with regulations and maximizes its revenue.
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Properly Calculate Time Units
Calculating time units and base units is an integral part of anesthesia medical billing, but it’s often prone to error.
Understanding proper time unit calculation means knowing the various formulas in play. Time units are added to whatever base units are assigned to the procedure to get the total units for billing purposes. For example, the formula used by commercial insurers is Base Units + Time Units + Physical Status Modifier = Total Units.
To calculate time units, take the total number of minutes spent on a procedure (start time to stop time, accounting for any breaks) and divide by 15. Any segment over seven minutes is rounded up to the next 15 minutes. So, a procedure that lasts from 8:00am to 9:08am would equal five units, not four. Many forms, however, require that you list the actual minutes (in this case, 68 minutes).
Remember that anesthesia time is considered the period of time in which the practitioner is present with the patient.
Understand Your Modifiers
Any anesthesia medical billing specialist should know modifiers intimately, as they play a major role in getting properly reimbursed.
There are several modifiers, including but not limited to the following:
- AA: Anesthesia Services performed personally by the anesthesiologist
- AD: Medical supervision by physician; more than four concurrent anesthesia procedures QK: Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals.
- QY: Medical direction of one CRNA/AA by an anesthesiologist
- QX: CRNA/AA service with medical direction by an anesthesiologist
- QZ: CRNA services without medical direction by an anesthesiologist
Modifiers are specific and must be carefully applied. Many denied or delayed claims were due to incorrect or missing modifiers.
Use Correct Physical Status Modifiers
As discussed above, total unit calculations involve adding physical status modifiers, which report the patient’s overall physical health.
Modifiers include:
- P1. A patient in normal health (0 units)
- P2. A patient with a mild systemic disease (0 units)
- P3. A patient with a severe systemic disease (1 unit)
- P4. A patient with a severe systemic disease that is life-threatening (2 units)
- P5. A patient whose survival without the operation is not expected (3 units)
- P6. A patient who has been declared brain-dead and whose organs are being removed for donation (0 units)
All insurers (except for Medicare) typically allow for additional physical status modifiers and total units if the patient has chronic conditions or other high-risk factors.
Anesthesia medical billing specialists must not miss or misuse physical status modifiers. Not only can this result in less revenue for a practice, it can also result in running afoul of compliance and triggering audits.
Properly Document All Qualifying Circumstances
Providers have the option of submitting qualifying circumstances to payors if the service provided was deemed necessary and reasonable for the patient’s circumstances. Leaving off these qualifying circumstances can dramatically reduce the potential for reimbursement, which can cause a loss of revenue for a provider.
For example, the +99100 code describes anesthesia that was provided for a patient who is younger than one year old or older than 70 years old. That is worth one additional unit of anesthesia. The +99140 code – anesthesia that is complicated by an emergency condition – is worth two units. At the top end are +99116 (anesthesia complicated by total-body hypothermia) and +99135 (anesthesia complicated by controlled hypotension), which are both worth five units.
Significant revenue potential can be lost without proper documentation and reporting of these qualifying circumstances. Failure to do so is one of the main reasons providers frequently miss out on all of their revenue potential.
Use Our FREE Calculator to Calculate Your Anesthesia Revenue Now!
Hire an Anesthesia Medical Billing Contractor
The best way to ensure proper compliance and complete collection of all potential revenue is to hire an anesthesia medical billing contractor that has the experience and expertise to specialize in billing and coding.
Doing so relieves overhead, since in-house staff can be reduced, and reduces overall costs in the form of better collections and payments. You can also avoid denied claims or delays in payments more successfully than most practices can do with in-house staff.
Contact a contractor to learn more tips for proper coding and billing for anesthesia providers.
