Correctly Report Anesthesia Time When Separately Billing Ancillary Procedures
By the Centers for Medicare & Medicaid’s (CMS)1 definition, anesthesia time begins when the anesthesia provider assumes care for the patient and begins to prepare the patient for the anesthesia service. It ends with the patient being placed safely under the care of another provider, and the anesthesia provider is no longer in personal attendance. Anesthesia time is dependent upon the continual face-to-face contact by the provider in conjunction with the surgical anesthesia service. This definition is the widely accepted standard, though some payers may not follow this definition.
Generally, anesthesia services are paid based on the base rate of the anesthesia procedure plus the time associated with the anesthesia care provided.
Post-operative pain management services, when not used as part of the anesthetic procedure, are separately billable. No time is reported in conjunction with the CPTs for billing purposes. Payment for these services is made based on the Relative Value Units (RVUs) of the procedure. The professional work component of payment includes the time associated in performing the procedure.
Similarly, other ancillary services such as arterial lines are paid at a flat-fee rate based on the work value of the procedure. Time spent performing these services is included in the payment rate.
As most separately identifiable procedures are performed prior to induction, time spent performing the post-operative pain service or ancillary services should be documented separately from the anesthesia time and should not be included in the reported anesthesia time. The exception to this occurs when these services are performed after induction. ASA position statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia2 says, “In the less common circumstance where a block is placed during a general anesthetic, time does not need to be deducted as the full anesthesia service is still being performed.”
Courtney Reasoner, CHC, CPC
1 Claims Processing Manual (Pub. 100-04, Chapter 12, Section 50. http://cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
2 Reporting Postoperative Pain Procedures in conjunction with Anesthesia. Committee of Origin: Economics
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