Medical Billing and Coding service leaders often face major challenges with respect to compliance and documentation integrity. This task is more daunting for anesthesia coders because, unlike all physicians, anesthesiologists do not get paid based on the fee-for-service model but rather on start-up units, time units, modifier units, and any other additional procedure. This is quite a complex calculation to an extent where Medicare uses a National Anesthesia Conversion Factor to ease the calculation of reimbursements. The formula for calculating the reimbursement is (Start/base units + time units + modifier units) X conversion factor = $.
Quick fact – There are other types of anesthesiologists who can also administer anesthesia including certified registered nurse anesthetists (CRNAs), anesthesiologist assistants (AAs), and dental anesthesiologists. Did you know that an anesthesiologist can supervise up to 4 CRNAs concurrently?
A huge chunk of anesthesia medical billing and coding services is depending on accurate documentation and this documentation involves a lot of intricacies as there are multiple phases involved in it, majorly consisting of three parts, 1. Pre anesthesia evaluation, 2. Intraoperative/procedural anesthesia (a time-based record), and 3. Postanaesthesia evaluation. There are also challenges other than documentation when it comes to anesthesia coding.
Common Challenges in anesthesia medical billing and coding
When an anesthesiologist cannot adhere to any of the said guidelines for the medical direction it is considered medical supervision. The HCPCS modifier for this is ‘AD – medical supervision by a physician: more than four concurrent anesthesia procedures’ which is used for the CPT codes 00100 through 01999. With respect to the medical billing and coding the payment for Medical supervision is based on three base units per procedure with an additional unit of time if the physician documents their presence at induction. The unit’s field must always be “1” when this modifier is used. Like Medical Direction there are set guidelines for medical supervision as well,
|QS||Monitored anesthesia care (MAC) services (can be billed by a qualified non-physician anesthetist or physician)|
|G8||Deep complex complicated, or markedly invasive surgical procedures|
|G9||Appended with an anesthesia code to indicate that the patient has a history of a severe cardiopulmonary condition|
|P1||A normal healthy patient|
|P2||A patient with mild systemic disease|
|P3||A patient with severe systemic disease|
|P4||A Patient with severe systemic disease that is a constant threat to life|
|P5||A moribund patient who is not expected to survive without the operation|
|P6||A declared brain-dead patient whose organs are being removed for donor purposes|
|AA||Anesthesia services personally performed by the anesthesiologist|
|AD||Supervision, more than four procedures|
|QK||Medical direction of two, three, or four concurrent anesthesia procedures|
|QX||Qualified non-physician anesthetist with medical direction by a physician|
|QY||Medical direction of one CRNA/AA by an anesthesiologist|
|QZ||Certified registered nurse anesthetist (CRNA) without medical direction by a physician|
Anesthesia Coding with Codessence
Codessence our CAC coding platform has a separate anesthesia tool inbuilt that can automatically calculate the base unit, time unit, and the modifying unit and code to the highest level of compliance and accuracy. It can also handle the most complex concurrency situation & advise you with an appropriate modifier which no other anesthesia coding tool is capable of. Curious to see how the tool works? You can directly schedule a demo of codessence here