Anesthesia providers face several unique billing challenges that make the process more involved and complex than what many other healthcare providers experience.
Navigating these difficulties is crucial to any facility’s financial health. Below are 5 anesthesia medical billing tips to help you achieve compliance and safeguard payer reimbursement.
Understand the Different Types of Anesthesia and Their Billing Codes
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.
Anesthesia codes in medical billing describe a general anatomic area or service which usually relates to several surgical procedures.
Make Sure You’re Using the Correct Modifier Codes to Accurately Bill for Anesthesia Services
Any claim for a healthcare service must clearly define what service/procedure was performed and why it was done.
Modifiers refer to the two-character indicators that help identify relevant details on a claim. Modifiers and codes are essential to increasing accuracy in reimbursement and coding consistency. They also help avoid duplicate billing and unbundling.
The Healthcare Common Procedure Coding System (HCPCS) code set indicates modifiers that are specific to anesthesia care and are required on claims submitted to Medicare and many other payers.
Know When to Use Global Billing Codes
The global period refers to the timeframe that covers the necessary services performed by a surgeon during the pre-operative, intra-operative, and post-operative stages of a procedure. This also includes any necessary services performed by members of that surgeon’s team. These services are included in the reimbursement of the original surgery, and they cannot be separately reported.
Under the global surgery rule, all the work surrounding and related to a surgical procedure is grouped into a single claim.
Understanding the specifics of the global surgery process is essential to ensure maximum reimbursement for your services rendered.
View the Global Surgery booklet here.
Use Appropriate Anesthesiologist Modifiers to Ensure Accurate Billing
Modifiers are important because they provide additional information and details concerning a procedure or service provided by an anesthesiologist. Modifiers help further describe a procedure by clarifying whether a service was personally performed, medically directed, or medically supervised by an anesthesiologist.
These modifiers are required to process a claim, so accuracy is imperative.
Examples of HCPCS Modifiers used in anesthesia medical billing and coding are:
- AA – Anesthesia Services performed personally by the anesthesiologist
- AD- Medical Supervision by a physician: more than 4 concurrent anesthesia procedures
- QK- Medical Direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
- QX – Qualified nonphysician anesthetist service: With medical direction by a physician
- QY – Medical direction of one qualified nonphysician anesthetist by an anesthesiologist
- QZ – CRNA service: Without medical direction from a physician
Understand How Anesthesia Services Are Reimbursed by Insurance Companies
To be reimbursed for anesthesia services, you have to bill insurance companies.
For commercial insurance companies, the following formula is used to report time units for provided anesthesia: Base Units + Time + Physical Status Modifier = Total Units
For Medicare, the following formula is used to report time units for anesthesia provided: Base Units + Time = Total Units
Anesthesia is calculated at 15-minute intervals (15 x 4 = 60). When a case runs over seven minutes, guidelines state to round up to the next 15 minutes provided.
Insurance companies reimburse for anesthesia services billed with codes and modifiers in accordance with the guidelines provided by The Centers for Medicare & Medicaid Services (CMS) and state guidelines/regulations.
Questions about Anesthesia Billing Services? Contact Coronis Health Today!
Coronis Health is a global revenue cycle management company offering specialized solutions to healthcare practices and facilities. By using industry-leading technology combined with high-touch relationship building, Coronis Health allows healthcare practitioners to focus on patient care, maintain financial independence, and cultivate financial success.
Medical billing for anesthesia is no easy feat. Coronis Health can help manage the process by handling its complexities and avoiding errors. To learn more about our anesthesia medical billing services, contact Coronis Health and request your free financial checkup today.