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Why CPT Code Modifiers Are Essential for Anesthesia Billing Claims

October 4, 2022

Common procedural terminology (CPT) modifiers are special codes – usually numeric or alpha – used by medical billers to indicate additional information or pricing associated with a specific CPT code. Anesthesia billing, like all other medical billing, includes the use of these modifiers, which are critically important for the purpose of reimbursement from payors.

What Are CPT Code Modifiers, and Why Are They Important for Anesthesia Billing Claims?

Modifiers are codes (both CPT and HCPCS) that divide into two categories and levels of information:

  • Level I – two numeric digits, maintained and updated regularly by the American Medical Association (AMA).
  • Level II – alpha digits (two letters, AA to VP), and updated annually by the Centers for Medicare and Medicaid Services (CMS). 
    • Codes are for the purpose of pricing or providing additional information
    • Pricing modifiers are listed first, followed by the informational codes
coronis health anesthesiologist injecting patient

Anesthesia codes in medical billing are especially critical, as they represent not only the documentation but also the start and end times of a surgery or procedure. The CPT code modifiers pull in critical pieces of information, such as a patient’s physical status, how many anesthesiologists provided services (or if services were provided by a CRNA), or whether the procedure was related to a screening examination. Anesthesia modifiers are so specific that they indicate the health status of the patient from a normal, healthy patient (CPT modifier P1) to a patient declared to be brain-dead, with organs being removed for donor purposes (CPT modifier P6).

These modifiers are necessary for anesthesia medical billing to ensure that anesthesia providers are reimbursed based on the work and the reason for the additional work, such as the following:

  • Increased intensity
  • Time 
  • Technical difficulty
  • Severity of patient’s condition
  • Screening procedure resulting in diagnostic procedure

Leaving just one component of the CPT code modifiers out of an anesthesia medical billing claim could mean the difference between full reimbursement and a significant decrease in payment.

How Do CPT Code Modifiers Impact Anesthesia Billing and Reimbursement Rates From Insurance Providers?

coronis health anesthesiologist billers administering treatment

CPT code modifiers for anesthesia billing are crucial and must reflect many components of services provided during a procedure. For example, per payor rules and regulatory requirements, the start and stop times are required in the documentation to indicate the amount of time spent with a patient during surgery. This is one of many modifiers that must be included in any anesthesia claim to receive full reimbursement. 

Anesthesia coding is challenging enough, and not including the appropriate modifiers can result in denied claims and loss of revenue.

Which CPT Code Modifiers Should Be Used for Anesthesia Billing Claims, and Why?

Anesthesia CPT modifiers are divided into two categories – pricing and informational codes. 

  • Pricing modifiers indicate the number of anesthesiologists, physicians, or CRNAs involved in a procedure or surgery. Codes range from AA to QZ and provide detailed specificity, such as anesthesia clinic services provided by an anesthesiologist or CRNA services without the direction of a physician.
  • Informational codes break into more detail and are a critical component for anesthesia medical billing. They indicate the physical status or health of the patient – whether a normal, healthy patient, or severely/chronically ill. Codes include P1 to P6. 

Anesthesia is critical for maintaining life support for a patient during surgery. Documentation for these services must be accurate and include critical variables like the number of anesthetists providing the service. There are also CPT code modifiers to document who did not provide support (i.e. CRNS service: without medical direction by a physician), which should also be included in billing claims.

How Can Incorrect Use of CPT Code Modifiers Lead To Denied Anesthesia Billing Claims?

Medical billing is about accuracy, and leaving any component of accuracy out of a claim will create errors and result in a loss of revenue. With anesthesia medical billing and coding, accuracy is even more critical, as it could result in a significant loss of revenue for an anesthesiologist or anesthetist. Pricing modifiers are straightforward, but information modifiers are complex and require extensive knowledge of anesthesia billing and coding. 

One missing code could mean the difference between a full reimbursement and a significant decrease in revenue. A billing expert must have consistent focus and attention to detail on the billing and coding process to ensure that claims are clean.

What Steps Can You Take To Ensure Accurate Coding and Billing of Your Anesthesia Services Using CPT Modifiers?

Accurate coding and billing for anesthesia are necessary, and the best way to ensure that your anesthesia services are captured accordingly is to use CPT code modifiers. Additionally, outsourcing your anesthesia medical billing services with Coronis Health ensures that you are receiving the highest possible reimbursement for the services you provide. 

Whether your anesthesia facility is hospital-owned, a private practice, or part of a university system, your coding and billing challenges will be handled by experts who are focused solely on anesthesia coding and billing. Coronis understands the importance of using CPT modifiers for all anesthesia services and understands even more about what happens if the codes are not included in a claim. Outsourcing is one step you can take to facilitate accurate billing and coding – and the best step is using Coronis Health for your billing and coding needs. If you want to step away from the burden of billing, give Coronis Health a call.

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