Let’s start with the most obvious question, what is Anesthesiology? It deals with before, during, and after perioperative care of the patient’s surgical procedure. Anesthesiologists play a vital role in a surgical procedure; they have to administer the right amount of anesthesia so that the patient doesn’t feel any pain during the surgery. Not only this, but they are also responsible for monitoring the vitals based on which they have to alter the dosage. After surgery, anesthesiologists are also responsible for waking up the patient. They have to be billed and reimbursed to the maximum based on the services.
Medical billing for anesthesia is not as simple as it might seem. When it comes to anesthesia billing, there are a number of factors and components to be considered while preparing a claim.
Anesthesia Billing Guidelines and CPT Codes:
Unlike other specialties (per service fee), anesthesia medical billing requires to be billed for base units, time spent, and modifiers used, therefore, a higher risk for errors and complications. How to avoid these errors? Outsourcing your anesthesia billing services to a well-reputed medical billing company can be quite beneficial and efficient. Following are some of the guidelines for anesthesia medical billing (according to CMS):
– The anesthesia services performed should be personally provided by the Anesthesiologist or at least supervised by a CRNA (Certified Registered Nurse Assistant) or AA (Anesthesia Assistant).
– Before the operation, a complete physical exam and medical history must be made so that the adverse effects of surgery can be minimized.
– Time units are a unique characteristic when it comes to anesthesia coding. Reimbursement or payment for the anesthesia services rendered is based on time, it also increases with the time spent. This is why the exact starting time and stopping time must be recorded. In case of interruption, the block of times (where the physician was present) must be added or reported.
– The evaluation services rendered must not be included in the anesthesia time unit rather, they are included in the base unit value. In case of cancellation, the E/M services provided by the Anesthesiologist must be recorded and paid for.
– Only one anesthesia code is allowed to be reported for the anesthesia service provided along with the radiological procedure.
– Only an anesthesiologist or anesthesia specialist can perform the monitored anesthesia care, administering anesthetic agents, sedatives, or hypnotics. Anxiety relief, care, amnesia, comfort, and pain relief are also part of the monitored anesthesia care.
Anesthesia Medical billing comprises about 13,000+ procedural CPT codes (therefore, increasing the chances of errors). According to CMS (Centers of Medicare and Medicaid Services), the CPT codes for services range from 00000 to 01999. This coding manual was last revised on 1st January 2022.
For higher reimbursement or payment, one can add additional anesthesia codes. These add-on codes include:
– +99100: – For administering anesthesia to a patient below 1-year-old and above 70 years old (the extreme ages). This add-on code should be listed separately from the primary anesthesia procedure.
– +99116: – Anesthesia complicated due to overall body hypothermia utilization. This add-on code should be listed separately from the primary anesthesia procedure.
– +99135: – Anesthesia complicated due to controlled hypotension utilization. This add-on code should be listed separately from the primary anesthesia procedure.
According to this, CPT Code 01996 was deleted in this latest revision. Following are some of the other anesthesia CPT codes: –
– Medical billing anesthesia code 01967 – Anesthesia for Obstetric Procedures like Neuraxial Labor Analgesia.
– 01916 to 01933 CPT codes are to represent the use of anesthesia for radiological procedures.
UControl billing is a well-reputed medical billing service provider where all the guidelines for medical billing and coding are followed so errors can be reduced hence, increasing the reimbursement rate.
Anesthesia Billing: – Factors and Components (To be Considered)
Anesthesiologists are billed and reimbursed based on various factors, unlike other specialties. Following are some of the components of anesthesia medical billing: –
– Pre-operative analysis and review: –
In order to calculate the dosage for anesthesia, the physician needs to analyze the exact patient history, medical record, use of tobacco, and other drugs – to prepare the pre-operative review!
– Anesthesia Sheet: –
Anesthesia Medical billing documentation requires all of the following details in the sheet:
o Base units: –
CMS (Centers of Medicare and Medicaid Services) publishes base units for Anesthesia Billing once a year. The skills required for an anesthetic service are represented through base units.
o Time units: –
Time units represent the time spent by the Anesthesiologist in administering anesthesia and monitoring the patient in pre-op, post-op, and during the surgery.
How to calculate the time units in anesthesia? Divide the total time (in minutes) spent in providing the anesthesia service by 15.
o Modifiers: –
There are a number of modifiers used in anesthesia billing to reflect the supervision or role of the Anesthesiologist. Here’s a list of modifiers used when billing for anesthesia services:
- Modifier AA
- Modifier QK
- Modifier QY
- Modifier QZ
- Modifier QX
All of these modifiers contribute to reflecting whether the procedure performed was medically supervised or personally performed by the Anesthesiologist.
– Post-operative analysis and review: –
As a pre-op review checks for symptoms before the surgery, a post-op review consists of medical records reflecting that the procedure and anesthesia didn’t result in any complications in the patient.
The formula for Anesthesia Billing:
(Base Units + Time Units + Modifiers) x Conversion Factor = Anesthesia Reimbursement
Billing for other medical services and Anesthesia Billing: –
When billing for anesthesia services provided to the patient, the following are some of the procedures that shouldn’t be billed with anesthesia: –
– Nerve Blocks
– Injection of therapeutic or diagnostic substances
These above-mentioned services are an integral part of anesthesia service (but are not limited to it), but they should not be billed or reported on the same day along with an anesthesia service (CMS Manual 2022).
There are a number of errors and challenges when it comes to medical billing, especially in anesthesia medical billing.
Errors and Challenges in Anesthesia Medical Billing:
Medical billing errors are the major reason behind claim denials and rejections, resulting in late payments and lower reimbursement rates. There exists various medical billing software for anesthesia billing out there and they come with their own set of challenges. Billing and coding errors or challenges in anesthesia billing involve the following: –
– Challenge or difficulty in reporting the exact time: –
As mentioned above, in anesthesia billing time units are a crucial part of the physician getting reimbursed for the services they rendered. This is why the exact and precise time spent must be recorded, billed and reported correctly.
There are various complications when it comes to reporting the precise time for anesthesia. Moreover, the medical claim must reflect, the exact start and stop times in both the continuous and the discontinuous time. Discontinuous time is when the provider or Anesthesiologist is not present with the patient for some reason. The claim must report the irregular time period, when the provider left and when they came back (hence all the starting and stop times).
The time for anesthesia billing starts exactly when the patient is being prepared for the anesthesia induction for their surgical procedure by the practitioner.
– Monitoring of the canceled anesthesia cases: –
Sometimes patient’s anesthesia induction or surgery also gets canceled, in this case, the reason for the cancellation must be reported in the medical bill. Also, the Anesthesiologist has to be reimbursed or compensated for the E/M services (evaluation and management services) they provided to the patient (in the case of surgery cancellation).
– Errors in the documentation: –
Creating an error-free bill with the right codes and modifiers won’t matter if there is an error in the documentation. With the correct documentation, using the right modifiers and CPT codes and the correct base and time units in the anesthesia billing results in faster payments.
Make sure you follow the anesthesia billing guidelines, use the updated codes, and complete documentation.
Outsourcing Anesthesia Medical Billing Services:
When it comes to medical billing, there are two options, hiring an in-house medical billing team or outsourcing it to a medical billing company. Having an in-house medical billing team means salaries, benefits, medical billing software (purchase & maintenance, etc.), computer equipment, and managing the operations. In-house medical billing might seem an option where you can control operations, but keep in mind that the team must be well experienced and knowledgeable to understand the precise factors and components of anesthesia billing.
Following are some of the benefits of outsourcing your anesthesia medical billing services:
– Affordable and Cost-effective services
– Lesser errors
– Higher reimbursement rate
– Improved revenue cycle
– A team of experienced medical billers and coders
Streamline your Anesthesia Billing with UControl Billing:
Unlike other medical and healthcare specialties, anesthesia is billed according to the units (base units and time units). And any error in the calculations of these units directly affects the reimbursement rate and revenues. Considering all the factors, outsourcing your anesthesia billing to a medical billing company like UControl Billing can be more efficient. With UControl Billing, you get:
– Timely follow-ups
– Billing in 24 hours
– Higher reimbursement rate
– Reduced errors
– Improved revenue cycle
– End-to-End Revenue Cycle management
– Affordable and competitive pricing
– Patient support
– Customer services
– HIPAA Compliance
– Reduction in Account Receivable (AR)
One of the biggest highlights of outsourcing your medical billing to UControl Billing would be that you won’t have to use any other EHR but your own. Our team of expert medical billers will efficiently perform the duties with your current EHR/EMR. Our team is highly experienced in handling any and all types of challenges regarding medical billing. You are in good hands!
We get it; medical billing can be tricky but can improve your revenue cycle if managed correctly. Our medical billing services include; eligibility verification, fee schedule analysis, review claim review and scrubbing (rule-based), claim tracking, and reduced claim rejections and denials.
Plan and Pricing with UControl Billing:
With UControl Billing, you get competitive pricing! Plus, on the side, you don’t have to worry about fixed prices anymore. Your costs are based on your monthly receipts. We get paid when you get paid, and it’s quite simple if your production faces a dip, so does your billing cost. We are dedicated to improving your revenue cycle and increasing the reimbursement rates; you get compensated properly for the services rendered.
We offer two pricing plans at UControl Billing:
- Medical Billing only
- Complete Revenue Cycle Management
You can focus on your primary cause, i.e., the patient care, and leave the medical billing to us. With UControl Billing, you get to run to medical practice with utter freedom and a team of certified medical billers to increase your revenues and reduce errors.
Frequently Asked Questions (FAQs)
- How do you bill for anesthesia?
Anesthesia billing is billed based on the time spent before, during, and after the surgery. It is reported with base units, time units, and the use of correct modifiers. The time for anesthesia billing is calculated in minutes. For instance, if the duration was 1 hour, it should be reported as 60 minutes. For calculating time units, divide the total time spent by 15.
- What is anesthesia in medical billing?
Anesthesia is the core element of any surgical procedure. It deals with before, during, and after surgery patient care. Unlike other specialties (which are based on a fee per service billing), anesthesia billing is based on the time spent. This is why precise time (start time and stop time), following anesthesia billing guidelines, and accurate documentation are essential for high reimbursement and timely payments.
- Is anesthesia coding based on a billing formula?
Time units play a vital role in the payments of anesthesia services rendered. This is why calculating the correct and exact time (continuous or discontinuous) is extremely necessary. The formula for anesthesia coding is;
(Base Units + Time Units + Modifiers) x Conversion Factor = Anesthesia Reimbursement
- When does the anesthesia billing start?
According to CPT (Current Procedural Terminology) guidelines for anesthesia medical billing, the time begins when the Anesthesiologist, CRNA, or AA starts preparing the patient for the procedure. Note that, the anesthesia time is the time when the Anesthesiologist is managing, supervising, or presenting with the patient.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.