As we’ve seen with the other major changes to the Relative Value Guide in 2019, the definition for accurate start and stop times has gotten more complex in order to allow for more flexibility. It seems counterintuitive that a more rigid definition can lead to more adjustability in practice, but it’s true. Surgery is a complicated process, and the recording of start and stop times of anesthesia is now more flexible to allow for the difficulty and variability of different surgical episodes.
Prior to 2019, Anesthesia time had been defined by the RVG as beginning “when the anesthesia provider begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesia provider is no longer in personal attendance, that is, when the patient is safely placed under post-anesthesia supervision.” (x) This simple definition does not allow for times when unavoidable complications may disrupt the anesthesia care. How does the practitioner account for these interruptions? Do you estimate the numbers as though the care has happened for continuous periods? Or do you choose to underbill to stay on the right side of an audit? The new definition of recording start and stop times alleviates these concerns.
Now, anesthesia time is still defined as “the period during which an anesthesia practitioner is present with the patient,” but may be counted in separate time blocks rather than continuously in order to provide a more accurate picture of the services provided to the patient. What does discontinuous anesthesia time look like? One example could be the time between the application of anesthesia and the start of a surgical procedure when a patient may be safely monitored by a non-anesthesia professional. Another example could be emergency transport of a patient who has already begun an initial contact with his anesthesia provider. Whatever the case, it is important to understand a few things about recording accurate start and stop times to remain compliant.
How to Record
The main thing to note is that discontinuous time is NOT to be used or recorded while a surgery is underway. Otherwise, there is a relatively simple equation used to generate payments from CMS codes that include these flexible time units. Most of the factors in this equation are predetermined codes, but time units are generated by the anesthesia practitioner.
(Base Units x Time Units x Modifying Units) x Conversion Factor =
Payments for Anesthesia Services
The Base Units, Modifying Units, and Conversion Factors are all codes provided to you that describe the type of surgical procedure performed and the required application of anesthesia. Time units are measured in minutes, with 15- minute increments totaling one (1) unit. There are 4 units in an hour, and decimal points can represent partial units as accepted by most providers. For example, anesthesia services rendered for a 93 minute procedure would be 6.2 time units, with the last three minutes correlating to ⅕ or 0.2 of a time unit. Medicare accepts time units up to the tenth decimal, so accuracy is crucial. It is important to record your anesthesia time as diligently as possible, both to make sure you are accurately billing for services rendered, as well as protecting yourself from expensive audits. Vigilance in recording accurate start and stop times for anesthesia services can save you time and money in the long run.
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