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Anesthesia Billing | Anesthesia Modifiers: Gotta Catch ‘Em All

When it comes to medical billing, surgeons have it easy. After the surgery is performed, they use a single CPT code that covers everything from the procedure itself to all pre-op and post-op visits with the patient. It’s as simple as can be: a single code covers everything, and the surgeon receives their full compensation without any complication.

If only anesthesia billing were that straightforward. Unlike our surgeon friends who can submit a single CPT code and call it a day, anesthesiologists must accurately record both base units and time units, in addition to several modifying factors, to receive the full compensation they are entitled to. If any details are left out or underreported, anesthesiologists can lose money.

Anesthesia billing isn’t foolproof: base units, time units, and all modifying factors must be accurately submitted to payers to receive full compensation.

You Need a Specialized Biller

Since anesthesia billing is so much more complicated than surgical billing, it doesn’t make sense to use the same billing service for both specialties. Yet that’s exactly what so many anesthesiologists do when they hire generalized billing services that cover dozens of specialties.

Instead, anesthesiologists need a billing provider as specialized as they are. Fusion Anesthesia has been handling billing services for only anesthesiologists for over 40 years. Their coders are deeply experienced in all aspects of anesthesia billing and maximize every claim by ensuring the appropriate base units, time units, and anesthesia modifiers are present and accounted for.

Fusion Anesthesia Knows Every Anesthesia Modifier

Many modifiers are unique to anesthesia, further complicating an already complex billing process. They’re used on claims to signify special situations that made an anesthesia case more difficult or risky as well as services rendered that are in addition to the main case.

When used appropriately, anesthesia modifiers represent significant revenue enhancement opportunities, but they can also be a minefield of potential under or over billing.

Some anesthesia modifiers add additional base units, while others are paid as a flat-fee service. Regardless of the type, Fusion Anesthesia are experts at catching all appropriate anesthesia modifiers, ensuring they’re properly listed on each claim, and then collecting the contracted rates for each modifier.

When Fusion Anesthesia is coding directly from a record, we tenaciously hunt for any additional details that could appropriately increase base units or add fees through anesthesia modifiers. If anesthesiologists are using billing slips, then we constantly remind them to report any modifying factors to ensure maximum appropriate revenue.

Fusion Anesthesia are experts at hunting down every last anesthesia modifier ensuring physicians receive their full compensation.

Anesthesia Modifiers

Below is a partial list of anesthesia modifiers. For each one, ask yourself if you had a recent case where one of these situations applied. If so, did your billing company include the modifier on your claim?

  • Physical Status: This anesthesia modifier considers a patient’s overall health and adds base units to account for the added risk and difficulty of treating sicker patients. If a patient has severe disease, an anesthesiologist might declare them physical status 3 or 4, which adds base units to the established amount for the procedure. Likewise, if a patient is expected to die if they don’t have the surgery they’re about to undergo, the anesthesiologist can declare the patient physical status 5 which would add an additional 3 base units onto the procedure.
  • Extreme Techniques: If an anesthesiologist performs an extreme technique, such as inducing hypotension or hypothermia, this also adds base units to the procedure.
  • Extreme Age: If the patient is extremely elderly, one base unit is added.
  • Emergency Procedures: Two base units are added if delaying surgery would be life-threatening to the patient.
  • Patient Position: If the patient is prone or lateral during the procedure, this can add base units.
  • Post-op Pain Injections: It’s not uncommon for a surgeon to ask an anesthesiologist to perform a post-op pain injection. For example, if the patient had knee surgery, the surgeon might ask the anesthesiologist to perform a peripheral nerve block in the patient’s leg to deaden post-op pain. Unlike other modifiers, post-op pain injections incur a flat fee rather than add additional base units. But like other modifiers, anesthesiologists must document and report these post-op procedures to get paid for them. Because these procedures are so common, Fusion Anesthesia is constantly catching post-op pain procedures that anesthesiologists have forgotten to document, ensuring their clients get paid for the work they performed.
  • Invasive Monitoring Lines: Though IV placement is included in anesthesia, anesthesiologists are sometimes asked to place arterial or central venous lines. These services entitle anesthesiologists to extra income, though they must be accurately reported and billed. Like post-op pain injections, invasive monitoring lines incur a flat fee rather than add base units.

Specialized Billing for Your Specialty

If anesthesiologists or their billing company miss any anesthesia modifiers, anesthesiologists lose money.

Fusion Anesthesia has a deep understanding of every single anesthesia modifier—an expertise they gained over 40 years specializing in nothing but anesthesiology. It’s highly unlikely that a generalized biller, whose main focus is ensuring accurate CPT codes, can help you appropriately increase your revenue the way that we can. Not only do we understand anesthesia billing better than general billing companies, we have a secret sauce that helps us outperform other anesthesia-specific billing companies.

Want to see how a specialized billing company like Fusion Anesthesia can boost your take-home pay by catching unreported modifiers? Get a free no-obligation audit of your last six months of claims.

Anesthesia jokes are funny - getting underpaid isn′t.

Contact us to learn how you can maximize your take home.

Anesthesia jokes are funny - getting underpaid isn′t.

Contact us to learn how you can maximize your take home.

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