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March 10, 2016

Reviewing the Anesthesia Billing Guidelines You Need to Know

March 10, 2016

anesthesia billing guidelines

If you are an anesthesia provider in the state of Alabama, there are certain guidelines you need to be aware of in order to abide by all policies and regulations and ensure you are properly billing and collecting your claims.

Here are a few anesthesia billing guidelines your practice should follow.

Claim Filing

Effective for dates of service on or after January 1, 2014, Blue Cross Blue Shield of Alabama requires claims for anesthesiologists, CRNAs, and AAs to be billed under the name and National Provider Identifier (NPI) of the provider who actually rendered the service.

Blue Cross does not recognize “incident to” billing for anesthesia services. All providers should render services based on the scope of their particular license and requirements of the State of Alabama. Practitioners (anesthesiologists, CRNAs, and AAs) must each file for the professional anesthesia services they performed electronically on the electronic 837 Professional 5010.

For CRNA services performed on or after January 1, 2014, services will no longer be reimbursed through the hospital Blue Cross Cost Study. Both CRNA costs and charges should be excluded from the costs and charges reported in the hospital Blue Cross Cost Study.

Coding

Qualified anesthesia providers may bill directly for services using CPT anesthesiology codes 00100 – 01999. While some surgical CPT codes are appropriate to use when billing anesthesia services (e.g., CPT code 36620), the majority of anesthesia services should be billed using codes in the range of 00100 – 01999.

Base Units

The base unit is the value assigned to each CPT code and includes all usual services except the time actually spent in anesthesia care.

Pre-operative and post-operative visits are usually included. When multiple anesthesia services are performed, only the anesthesia services with the highest base unit value should be filed with total time for all services reported on the highest base unit value. The base units’ value should never be entered in the “units” field when filing claims.

Effective for dates of service on or after January 1, 2014, Blue Cross will utilize the Centers for Medicare & Medicaid Services (CMS) base unit values.

Anesthesia Time and Calculation of Time Units

According to CPT guidelines, anesthesia time begins when the anesthetists begins to prepare the patient in the operating room or in an equivalent area and ends when the anesthetist is no longer in personal attendance and the patient may be safely placed under post-anesthetic supervision.

Anesthesia time should be reported in minutes. Effective for dates of service on or after January 1, 2014, for all anesthesiologists, CRNAs, and AAs, one unit of time will be allowed for each 15-minute increment of anesthesia or a fraction thereof.

Reimbursement for time-based anesthesia is based on the following formulas:

Anesthesia Personally Performed by Anesthesiologist or CRNA (AA or QZ Modifier)

(Base Factor + Total Time Units) x Anesthesia Conversion Factor x Modifier Adjustment = Allowance

Anesthesia Performed under Medical Direction (QK, QX and QY modifiers)

[(Base Factor + Total Time Units) x Anesthesia Conversion Factor] x Modifier Adjustment = Allowance for each provider 

An anesthesia “base unit” is the number of units assigned for the anesthetic management of surgical procedures using nationally recognized anesthesia base value standards. Base units are automatically calculated and should not be reported on the claim form. Blue Cross will utilize the CMS base unit values.

Anesthesia time should be submitted on the claim as total minutes. For example, one hour and nine minutes of anesthesia time is billed as 69 minutes. Blue Cross then converts minutes into 15-minute increments. This calculation would be four 15-minute time units and 9/15 of one unit. Total time units for this example are 4.6.

Blue Cross recognizes that the patient must be prepared immediately prior to induction and that some time may be spent immediately after the conclusion of the surgical procedure. Generally, no more than one unit should be necessary to prepare the patient for post-operative transfer to the recovery room. It is inappropriate to bill for anesthesia time while the patient is waiting in a holding area. If it is necessary for a more extensive service to be provided, documentation must be provided in the patient’s medical record to substantiate medical necessity. It is inappropriate to bill time units for services such as administration of blood products or antibiotics in the holding area, when such services could be provided in another area of the hospital or facility. 

Help with Following Anesthesia Billing Guidelines

If you need help with following the above guidelines – or any policies or regulations for billing in Alabama – contact a qualified and experienced third-party billings provider. We specialize in billing and coding for anesthesia providers and have the expertise and hands-on experience needed to navigate this process smoothly and efficiently.
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