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The Challenge of Anesthesia Charge Capture

June 3, 2024

In contrast to medical billing in the main, the submission of anesthesia claims in particular is uniquely intricate because of the multiple ways in which reimbursement is determined—starting with what’s found on the anesthesia record. While every other specialist dictates a narrative report describing the services provided to the patient, the anesthesia provider documents multiple data points, including what the surgeon did and how the patient responded to the various drugs and agents administered in connection with the case. Providers take the typical grid for granted; but, from a billing perspective, it poses a variety of interesting challenges.

Form and Function

Accurately determining all appropriate coding options and the amount of billable anesthesia time requires a careful review of the entire record, even when the information is transmitted electronically from an automated anesthesia record. While the basic format of the record has existed for dozens of years, details of a specific practice’s record reflect a complex and dramatic evolution given the diverse objectives of anesthesia documentation in today’s specialty. Generating an appropriate and valid claim from each practice’s record is no simple feat because each group’s anesthesia record is unique, with its own strengths and weaknesses.

While the specific design of a practice’s record is often a subject of much discussion and review, which is not the topic of this discussion, every practice tries to find the best means of communicating this critical information to the billing staff. The result is that there are many options. The classical solution is to simply submit a copy of the paper record together with the patient demographics to the billing office. This can be accomplished in multiple ways. The documents can be scanned then emailed, faxed or placed on an SFTP site for the billing office to retrieve. If they are not scanned, they can be collated and mailed via United States Postal Service or via express mail. If the facility has an electronic medical record (EMR) those files can either be transmitted directly to the billing office or the facility can set up access for the billing office to be able to batch print the billing records by date of service. If the facility is on paper and does not have an EMR, Coronis Health has an EMR Solution, Anesthesia Touch, that can be utilized as well.

The Electronic Era

A number of years ago, the manufacturers of anesthesia machines began adding automated anesthesia records to their systems. The intent was to simplify record keeping by taking advantage of the data trails being generated by the various monitors. Although the advantages of such an option seemed obvious to the engineers, they were not always so obvious to providers who had gotten quite used to completing their own paper records. The primary concern was that the automated records might include artifact data points such as dramatic rises in blood pressure that were not normally documented by the provider. The chief complaint was, that if this were the case, it might provide ammunition for attorneys if there were an adverse outcome. Most systems now include logical ways to edit the record.

One of the selling points of automated anesthesia records was that they would simplify and enhance the transfer of all the details of each case to the billing office. The idea was that, once the record was closed, the details of the case could be zapped into the billing computer. The assumption was that appropriate billing software could read and interpret all the details of a case and transform it into a billable file format. Unfortunately, this is not always the case. The reality is that anesthesia billing is sufficiently complicated that a certified coder must review each record after it has been transferred to ensure that the codes are correct, the time is calculated properly and there is relevant documentation of any additional services (such as nerve blocks for post-operative pain). It is also important to remember that because many claims will be submitted with ASA versus CPT codes, there is often a requirement to confirm details of the surgery (such as lower versus upper abdomen or one lung technique) that might not otherwise be part of the surgical details.

The percentage of practices that have anesthesia machines with automated records is certainly increasing as hospitals make the investment to enhance the overall level of electronic record-keeping in their facilities. Academic centers have been on the forefront of this, and the most commonly deployed systems have profited greatly from the practical experience of academic providers. Even so, no system is without limitations and must ultimately be customized to the specific needs and conventions of a practice. It is just as important to remember, however, that it is often the administration—and not the anesthesia providers—who make the final decision as to what to purchase. Whether all hospitals will eventually make such an investment is difficult to say; but, clearly, the impact of such systems has been significant.

Practice Preferences

Every practice must generate appropriate, complete and compliant records for every case and get the details of each case to the billing staff in a format that allows them to generate valid claims for payment. As discussed, there are many options that may be used to accomplish this. With all our experience in anesthesia billing, we have found that anesthesia practices can have unique idiosyncrasies and a varying set of circumstances, therefore every practice must take responsibility to ensure that their billing office is receiving what they need to ensure that cashflow is enhanced and compliance risks minimized.

Given the ever-changing technology options, you may want to reach out to your account executive to ensure that your practice is benefiting from the most appropriate solution.

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