Part B Insider (Multispecialty) Coding Alert

Published on Fri Dec 13, 2013 PDF

Question: I’m trying to figure out when to “round up” units when the anesthesia time exceeds 15 minutes. I’ve read that in order to round up to the next unit, the time must have exceeded at least half (7.5 minutes) of the next 15 minute time increment. So, for example, 26 minutes divided by 15 is 1.7. Would I round this up to 2 units or keep it at 1?

Answer: If the amount of time has reached at least the halfway point of the next time unit, you can add the extra unit to your claim. So, in your example, 26 minutes counts as two 15-minute time units. Just always be sure that the provider’s documentation clearly states the start and stop times for anesthesia so your calculations are accurate.

Check point: Some payers prefer that you file claims with the total number of anesthesia minutes instead of time units. The payer then takes the minutes you provide and calculates the units themselves.

According to the CMS Claims Processing Manual 100-04 Chapter 12, for example, “Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished on or after January 1, 1994, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place. The A/B MAC does not recognize time units for CPT^® codes 01995 or 01996.”