Tips for Anesthesia Billing

Tips for Anesthesia Billing

Anesthesia billing is challenging and complex because you need a basic understanding of how anesthesia is administered as well the ins and outs of payer requirements or your claim may be denied.  Anesthesia billing is not sole responsibility of anyone but requires something of everyone from the billing team member all the way to the physician.

If you like to succeed in anesthesia billing, you need to follow the top tips given in the following briefs.

Focus on process of reconciliation

The first step crucial step for successful anesthesia billing is to ensure you are billing for every service provided to every patient. You may record loss of hundreds of dollars of revenue with just one overlooked case. Hence to avoid such loss billing teams and physicians need to work together to ensure that all charges are being billed.

Calculate time units properly

It is often observed that calculation of time and base units are error prone. However they are integral part of anesthesia medical billing and should be error free. There is an addition of time units with whatever base units. Generally these base units are assigned to the procedure to get the total units for billing purposes.

For example, the formula used by commercial insurers is Base Units + Time Units + Physical Status Modifier = Total Units.

Know your Modifiers

As a physicians it is mandatory to aware of several modifiers and its correct usage to ensure proper claims payment.  Anesthesia “provision/supervision” modifiers (-AA, -QK, -QY, -QZ, and -QX) explain the role of the anesthesiologist and CRNA. To understand whether an anesthesia procedure was personally performed, medically directed, or medically supervised by an anesthesiologist these modifiers are essential. Let’s look at above modifiers in detail.

Anesthesiologist

SR.No Modifiers Description
1 AA Anesthesia services personally performed by the anesthesiologist
2 QY Medical direction of one CRNA by an anesthesiologist
3 QK Medical direction of two, three or four concurrent anesthesia procedures
4 AD Supervision, more than four procedures

CRNA

SR.No Modifiers Description
1 QX Anesthesia, CRNA medically directed
2 QZ Anesthesia, CRNA not medically directed

Physical Status Modifiers

SR.No Modifiers Description
1 P1 A patient in normal health (0 units)
2 P2 A patient with a mild systemic disease (0 units)
3 P3 A patient with a severe systemic disease (1 unit)
4 P4  A patient with a severe systemic disease that is life-threatening (2 units)
5 P5 A patient whose survival without the operation is not expected (3 units)
6 P6 A patient who has been declared brain-dead and whose organs are being removed for donation (0 units)

If the patient has chronic conditions or other high-risk factors then all insurers (except for Medicare) allow for additional physical status modifiers and total units.

Bill the procedure with the highest base value when providing multiple procedures

When working in multiple areas of the spine or abdomen you need to carefully glance at the code descriptions for procedures you are performing. You cannot bill codes for more than one procedure however some ASA codes include multiple areas in their descriptions which results in higher base units. Hence choosing the most precise code bill help you avoid under-billing for your work.

Prepare for ICD-10 through clinical documentation improvement and code set familiarity.

Anesthesiologists are heavily relying on the surgeon for the information about the patient and his condition hence specificity of ICD-10 is challenging for anesthesiologists. You need to familiarize yourself with what is required as well as understand properly code system using ICD-10.

Now you will have clear understanding of anesthesia billing however, the best way to ensure proper compliance and complete collection of all potential revenue is to hire an anesthesia medical billing provider, we are having the experience and expertise to specialize in anesthesia billing.

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