Anesthesia is the most complex of any specialty to bill due to the large number of documents that must be reviewed to accurately code and bill as well as the formula used to bill (Base Units + Time Units + Modifiers) x Conversion Factor.
Most hospitals are now using some type of Electronic Health Record (EHR) and while those EHRs are great for capturing patient information and charting, we have found many deficiencies when it comes to billing for anesthesia services. There are often disconnects between anesthesia clinicians on where services such as blocks should be documented and whether the hospital billing staff is receiving those charges to bill. Seasoned anesthesia coders and billers will know what procedures have ancillary anesthesia services to be billed whether or not the service has been documented (i.e. common surgeries that require post-operative pain management or vascular line placements for additional monitoring during complex surgeries.
Concurrency analysis is another area of concern for hospitals. Concurrency is defined as the maximum number of procedures that the anesthesiologist is medically directing within the context of a single procedure and other procedures overlap each other. Unless you are utilizing an anesthesia specific billing platform that is designed to identify errors, such as concurrency, you may create compliance issues for your hospital. Once all charges and times are entered, an anesthesia specific billing platform will run a concurrency analysis to identify overlapping times, invalid times, inconsistent or suspect coding, and modifiers, etc.
In addition, it is crucial to reimbursement to properly use anesthesia modifiers. There are modifiers that affect reimbursement that denote whether the case was performed solo by an anesthesiologist (AA) or if the case involved medical direction (QK) as well as other modifiers for CRNAs and medical supervision. Physical Status modifiers are used to distinguish between various levels of complexity of the anesthesia service provided, i.e., P1 for a normal healthy patient. While Medicare does not recognize or pay additional units for Physical Status many private payers do, and these reimbursable charges are often missed.
Non-Operating Room Anesthesia procedures (NORA) is another area that we find revenue leakage. These are procedures such as intubations and heart catheterizations performed outside of the OR. These procedures often must be manually extracted from the hospital EHR and most hospitals do not have a process in place to capture these procedures nor has the staff been trained to recognize this is an issue.
Anesthesia revenue cycle requires coders certified in anesthesia and pain management (CANPC) as well as medical billers with deep anesthesia billing expertise to ensure every anesthesia service is accurately and compliantly coded and billed to the highest level of specificity to capture maximum reimbursement.
By: Jeanette Mini