From CPT to Modifier: How to Code Anesthesia Services Accurately
Author: Marcy Garuccio, Director of Coding, Anesthesia, nimble solutions
Inaccurate coding and incomplete procedure documents are two of the top issues affecting anesthesia revenue cycle efficiency. Anesthesia coding is incredibly complex because it relies on the accuracy of procedure notes and an individual coder’s knowledge of coding guidelines.
Certified anesthesia coders know how to record the duration of procedure, the procedure’s level of difficulty, and other modifying factors that vary by payer, anesthesia provider, and anesthesia units.
nimble solution’s specialized knowledge in the anesthesia revenue cycle helps anesthesia groups regain lost revenue and maximize profitability.
In this blog, we’ll share our top 5 anesthesia coding strategies to improve revenue cycle efficiency.
Understand anesthesia coding guidelines
The more familiar your coding team is with anesthesia coding guidelines, such as CPT codes and time-based calculations, the more you can avoid compliance and costly claims issues.
For example, the anesthesia coding process includes mapping the CPT code for the surgery with the corresponding anesthesia CPT/ASA codes. This means anesthesia coders must be knowledgeable in anesthesia codes and CPT codes to maintain accuracy.
Anesthesia reimbursement also includes time-based calculations. When multiple anesthesiologists and CRNAs are on the same case, rules for time-based verses unit-based coding can become complex. A well-informed, certified anesthesia coding team will ensure compliance and help you avoid potentially expensive claims issues.
Review procedure notes and anesthesia records
Accurate coding requires detailed documentation. Procedure notes and anesthesia records are used to identify the anesthesia start and stop times, the anesthesia technique used, and any anesthesia-related complications that occurred during the procedure.
Creating a checklist for each requirement can help your team easily identify any missing information within the pre-anesthesia evaluation, intraoperative/procedural anesthesia, and post-anesthesia evaluation reports.
Code for the correct anesthesia procedure
Anesthesia services can be performed by anesthesiologists, nurse anesthetists, and anesthesiologist assistants. Each practitioner is qualified for a specific range of procedures and payer reimbursements reflect those specialized qualifications.
Coding for the correct anesthesia procedure involves applying the appropriate code for the administrating practitioner so the corresponding reimbursement is accurate. For example, if an anesthesiologist performed general anesthesia and you code for a CRNA instead, you’ll either receive a claim denial or a lower reimbursement.
Plus, each anesthesia procedure has its own specific code. If you know the correct codes for your anesthesia providers and the procedures they perform, you’ll avoid underbilling, overbilling, or resubmitting a claim.
Be aware of bundling rules
Knowing when your services are meant to be bundled and when they are to be billed separately will help you avoid claim denials, overbilling, and potential compliance issues.
Anesthesia services play a vital role in managing pain, discomfort, and physiological responses during surgical or medical procedures. It is important to note that these services should always be billed separately from the surgical procedure. Anesthesia cannot be included in the procedure billing and therefore must always be submitted as a separate claim.
However, it is worth mentioning that post op pain injections may be bundled into the anesthesia procedure. This is the only instance where bundling rules can apply to the anesthesia billing processes.
Know the modifiers and when to use them
Modifiers are two-digit codes appended to a CPT code to provide additional information. In anesthesia coding, modifiers are commonly used to indicate specific circumstances that affect reimbursement. General medical billing software and medical coders unfamiliar with anesthesia-specific requirements often miss this key component of the coding process.
For example, modifiers are used to show medical direction or medical supervision. The modifier “AA” indicates the anesthesia was administered personally by the anesthesiologist. The modifier “QK” indicates the supervising physician medically directed two to four concurrent anesthesia procedures. ¹
If the appropriate modifier is not used, Medicare can reject the claim or reimburse at a lower rate.
Key Takeaways for Anesthesia Coders
Anesthesia coding and payer guidelines are subject to frequent updates. Certified anesthesia coding specialists attend ongoing education and training courses to stay current on the latest trends affecting the anesthesia revenue cycle.
The best way to improve your coding knowledge is to attend workshops, seminars, and webinars. The more you know about documentation and coding practices, the more precise your anesthesia revenue cycle will become.
Are anesthesia coding errors impacting your revenue?
A partnership with a revenue cycle management company specializing in anesthesia can provide you with the right tools and industry knowledge to improve accuracy and compliance.
Find out How an Anesthesia Group Enhanced Cash Flow with nimble’s RCM Expertise in our anesthesia case study.
Are you looking for ways to improve your revenue cycle management? Take the first step towards optimizing your revenue cycle process by requesting a revenue assessment from our team of RCM experts. Request a demo.
- Anesthesia Payment Basics Series Codes and Modifiers. (n.d.). Www.asahq.org. https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-codes-and-modifiers