Pre-Anesthesia Era

Before going for any surgery, we usually tend to think about the education, expertise, experience and skill of the surgeon performing the surgery. The role and expertise of an anesthesiologist hardly cross our minds. However, before 19th century patients who had to undergo operations and surgeries hardly contemplated on the skillset of the surgeon. The unapologetic and unabashed fulminations of surgical instruments able to cause pain and distress used to occupy the minds of patients during surgery and haunting images of gruesome procedures post-surgery, if they were fortunate enough to survive. Dare imagining the patients held down by the dressers on vertical elevated chairs, their arms and legs tightly locked while surgeons performed operations ignoring completely the desperate pleas and cries of the patients.
The invention of anesthesia and its successful adaptation over time in medical science has not only made the surgeries less troublesome for the surgeons but has also relieved the patients from pain and misery.

Role of an Anesthesiologist

The job of an anesthesia provider is to meet with the patient and his/her surgeon before the start of surgery in order to assess the overall health and medical history of the patient. The quantity of the dosage to induce consciousness depends on the health and medical history of the patient. Furthermore, an anesthesiologist monitors the vital signs of the patient along with patient’s surgeon and also examines the patient post-surgery to ensure that the patient is comfortable and is not experiencing excruciating pain.
It also falls under the domain of an anesthesia provider to take care of the patients who don’t require or need general anesthesia. Anesthesiologists also deal with the patients suffering from chronic or recurring pains.

Essentials of Anesthesia billing

Anesthesia can be best described as the careful administration of the right dosage of the drug to put patient in deep slumber during the surgery. Anesthesia billing formulates a different criteria of reimbursements as compared to other practices. Instead of following a general fee-for-service rule applicable to almost all the specialties, anesthesia providers are compensated based on time units. However, the process of anesthesia billing is highly complicated and anesthesiologists have to be extra careful while documenting the procedural details for maximum reimbursements. Because of anesthesia billing complex nature of documentation and coding, it is more prone to errors which results in aging disrupting the revenue cycle for the practice.

Documentation

An anesthesiologist must document all procedures as clearly as possible in great details. Lack of legible anesthesia records and procedures during surgery handicaps the ability of an anesthesia provider to get maximum reimbursements form the payers. In the world of anesthesia billing ‘if it isn’t documented, it didn’t happen’ rule applies. Therefore, it is of great importance to be as clear and coherent as possible when documenting the anesthesia procedure essentials.

Medical Coding

The ever changing and evolving world of anesthesia billing requires equally trained and experienced medical coders with deep and clear understanding of rules and regulations of the complex procedures and have the ability to attach the right codes and a billing team able to carry out them throughout the process. To put things into perspective anesthesia billing procedures are comprised of approximately more than 13000 codes. Moreover, there are additional codes which are crucial in generating high revenue. Coders have to be extra mindful and cautious when generating codes for the anesthesia procedures. Able to extract right information from the documentation sent by anesthesia providers is a must have skill for any medical coder. Any error no matter how infinitesimal can rend the cash flow system for the practice.
Following are the explanations of some key documented procedures for anesthesia billing which if done right by anesthesia providers will not only yield higher revenue returns for them but also make easy for the coders and billers to attach codes and submit clean claims timely.

Report Time

It is the process of recording the time when an anesthesiologist begins and ends the care of the patient. It is a complicated process where documenting accurate and exact details are crucial if the provider wants to get reimbursed properly for his efforts and services. Anesthesia time starts as soon as an anesthesiologist starts giving the patient administered dosage in order to induce unconsciousness so that the surgeon can perform surgery. Anesthesia time marks the end when an anesthesiologist is no longer monitors the patient vitals personally. The anesthesia time is recorded in minutes and rounded off to next 5 minutes in most scenarios.

Considerations for reporting Time
i- Discontinuous Time: highlights the interruptions or breaks whenever an anesthesia provider is not personally attending the patient for whatever reasons. Documented record must be able to show that when precisely care is stopped and resumed over the course of the surgery.
ii- Relief Time: occurs when one anesthesiologist takes over the case from another anesthesia provider. Documenting accurate relief time is of paramount importance for maximum reimbursements.
iii- Post-Anesthesia Care Unit (PACU): Medicare has a clear ruling on PACU time which is under seven minutes. Unclear and ambiguous documentation of anomalies may result in revenue loss for the practice.
The general formula for calculating anesthesia billing reimbursement is: (Base units + Time units + Modifiers) * Contractual Rate = Allowable Anesthesia Charge Base units
Reflects the complexity and amount of skills needed to provide anesthesia service. Centers for Medicaid and Medicare services (CMS) publishes base units once every year. Time units

Represents the time anesthesiologists spend with patients in administering the dosage and monitoring the condition of a patient before, after and during the surgery.

Modifiers

Are critical in determining what kind of exact procedures are carried out by an anesthesiologist during the surgery. They are essential in order to determine if an anesthesia procedure is performed personally, medically directed or supervised by an anesthesiologist. If the medical coders and billing teams are not well versed with the assignment and usage of modifiers, it will result in less revenue generation.

Following are some of the key modifiers.
AA: Anesthesia services performed personally by an anesthesiologist.
QY: Medical direction of one certified registered nurse anesthetics (CRNA) or an anesthesia professional.
QK: Medical direction by a physician of two, three or even four concurrent anesthesia procedures.
AD: Medical supervision for more than four concurrent anesthesia procedures.
QX: CRNA service with medical direction by an anesthesia physician.
QZ: CRNA service without medical direction by a physician.
QS: Monitored anesthesia care service.
8: Monitoring of anesthesia care for deep, complex, complicated or invasive surgical procedure.
9: Monitoring of anesthesia care for patients who have history of severe cardio condition.
Along with alphabetic modifiers there are also physical status modifier which are appended to an anesthesia claim to indicate the health condition of the patient. Physical status modifiers range from P1 to P6 and are as follows along with the units. One unit equals fifteen minutes of the anesthesia time.
P1:0 indicates normally healthy patient.
P2:0 indicates mild systematic disease.
P3:1 is an indication of severe disease.
P4:2 is a life threatening disease.
P5:3 is a moribund patient whose chances of survival without operation are grim.
P6:0 a brain-dead patient whose organs are being removed for donor purposes.
In order to increase the rate of successful claim submissions and decrease aging it is wise to hire the services of professional billers who understand the challenges and complexities of anesthesia billing and take up with the insurers.
Vigilant Medical Billing Services (VMBS) houses the trained and certified coders and billers who specializes in dealing with the intricacies of anesthesia billing and also deploys the artificial intelligent systems to scrub the human entry errors for successful timely submission of claims. We at VMBS are well aware of all the nuances and nitty-gritty involves in anesthesia billing and are committed to serve our clients with diligence and efficiency. By outsourcing our services we ensure higher revenue generation and peace of mind from financial worries.