Calculating time units for anesthesia billing and coding is extremely important. Failure to do so accurately can result in denied or delayed claims, which negatively impacts revenue. It can also result in audits which can further hurt a practice's revenue and reputation.
Here is a guide to correctly calculating time units for all claims and reports, to ensure your claims go smoothly and are as accurate as possible.
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Determining and Reporting Anesthesia Time
According to Current Procedural Terminology (CPT) guidelines, anesthesia time begins when the provider – the anesthetist – starts preparation for the patient, either in the operating room or another similar area. Note that time spent reviewing medical records before the surgery is not billable. This is a part of preoperative valuation, which is calculated in the base units.
Anesthesia time ends whenever the provider is no longer personally attending the patient, and when the patient is safely placed into post-anesthetic supervision.
The proper way to report anesthesia time is to record it in minutes. One unit of time is recorded for each 15-minute increment of anesthesia time. For example, a 45-minute procedure, from start to finish, would incur three units of anesthesia time. Being exact is required, since Medicare pays to one-tenth of a unit. Do not estimate the time or round up or down inappropriately. For example, for a 63-minute procedure, one would receive 4.2 time units (four time units x 15 minutes plus 1/5th of a time unit, or 0.2).
The Formula for Reimbursement
Using time units calculated from anesthesia time, one can calculate reimbursement for a procedure using a certain formula, depending on who performs the anesthesia.
For anesthesiologists or CRNAs:
(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment = Allowance
For anesthesia performed under medical direction:
[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment = Allowance for each provider
One can see how accurate time unit calculation can play into and directly affect the total charge, which in turn impacts revenue.
Considerations for Billing and Reporting Time
There may be interruptions in care during a procedure, marked by when the provider is no longer personally attending the patient. By recording the exact times care was interrupted, one can accurately report discontinuous time.
For example, if the anesthesiologist begins care at 8:00, but has care interrupted at 8:24 and resumes care at 8:36 before ending care at 9:04, there would be 52 minutes of anesthesia time. This would translate to 3.47 time units.
What Not to Bill
Generally speaking, most insurers allow for no more than one time unit to prepare patients for postoperative transfer to recovery. Insurers also do not allow billing for anesthesia time while the patient is in a waiting room or holding area. Also, when in the holding area, patients usually cannot be billed for antibiotics or any blood products that are administered. This is particularly the case when those services could be performed in another part of the facility.
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