Guidelines for Anesthesia Services Billing
Anesthesia services include, but are not limited to, pre-operative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services. In this article, we will be reviewing guidelines for anesthesia services billing which will help you in accurate insurance reimbursements.
Applicable CPT Codes
Anesthesia procedure codes describe a general anatomic area or service which usually relates to a number of surgical procedures. While paying most of payers, only one anesthesia code is reported unless the anesthesia code is an Add-on Code (AOC).
- The Current Procedural Terminology (CPT®) code range 00100 to 01860 specify ‘Anesthesia for’ followed by a description of a surgical intervention.
- The CPT code range 01916 to 01942 describe anesthesia for radiological procedures.
- The CPT code range 01951 to 01999 describe anesthesia services for burn excision/debridement, obstetrical, and other procedures.
- The CPT code range 99151 to 99157 describe moderate (conscious) sedation services. Note that CPT codes 01935 and 01936 were deleted in January 1, 2022.
Reporting Time Units
A unique characteristic of anesthesia coding is the reporting of time units. Payment for anesthesia services increases with time. In addition to reporting a base unit value for an anesthesia service, the anesthesia practitioner reports anesthesia time. Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient (i.e., when the patient may be placed safely under post-operative care). Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption. However, if it is medically necessary for the anesthesia practitioner to continuously monitor the patient during the interval time and not perform any other service, the interval time may be included in the anesthesia time.
Evaluation after Anesthesia Service
It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation before surgery. This is considered part of the anesthesia service and is included in the base unit value of the anesthesia code. The evaluation and examination are not reported in the anesthesia time. If a surgery is canceled, after the pre-operative evaluation, payment may be allowed to the anesthesiologist for an Evaluation & Management (E/M) service and the appropriate E/M code may be reported.
Similarly, routine post-operative evaluation is included in the base unit for the anesthesia service. If this evaluation occurs after the anesthesia practitioner has safely placed the patient under post-operative care, neither additional anesthesia time units nor E/M codes shall be reported for this evaluation. Post-operative E/M services related to the surgery are not separately reportable by the anesthesia practitioner except when an anesthesiologist provides significant, separately identifiable ongoing critical care services. If permitted by state law, anesthesia practitioners may separately report significant, separately identifiable post-operative management services after the anesthesia service time ends. These services include, but are not limited to, post-operative pain management and ventilator management unrelated to the anesthesia procedure.
Post-operative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon. The surgeon is responsible for documenting in the medical record the reason that care is being referred to the anesthesia practitioner. In certain circumstances, critical care services are provided by the anesthesiologist. Certain procedural services such as insertion of a Swan-Ganz catheter, insertion of a central venous pressure line, emergency intubation (outside of the operating suite), etc., are separately payable to anesthesiologists if these procedures are furnished within the parameters of state licensing laws.
Treatment of Post-Operative
The physician performing an operative procedure is responsible for treating post-operative pain. Treatment of post-operative pain by the operating physician is not separately reportable. However, the operating physician may request that an anesthesia practitioner assist in the treatment of post-operative pain management if it is medically reasonable and necessary. The actual or anticipated post-operative pain must be severe enough to require treatment by techniques beyond the experience of the operating physician. For example, the operating physician may request that the anesthesia practitioner administer an epidural or peripheral nerve block to treat actual or anticipated post-operative pain. The epidural or peripheral nerve block may be administered pre-operatively, intra-operatively, or post-operatively. An epidural or peripheral nerve block that provides intraoperative pain management is included in the anesthesia code and is not separately reportable, even if it also provides post-operative pain management.
Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. To describe guidelines for anesthesia services billing, we referred Medicare guidelines as most payers consider Medicare guidelines as standard. Still, you are advised to check payer-specific billing guidelines and patient insurance coverage for accurate billing. In case of any assistance needed in billing and coding for your practice, contact us at 727-475-1834 or email us at info@legionhealthcaresolutions.com