Wiki Anesthesia COding

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stormygirl01

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I had a doctor ask if it's true that it's 1 unit per 15 minutes up to 4 hours. Is it true that after 4 hours it goes to 1 unit every 10 minutes? Where can I go to see the guidelines for this?
 
Stormygirl,

Fifteen minute time units seems to be the most common conversion, however, I have heard of groups in other areas that bill 10 minutes time units all the time! Medicare/CMS defines a time unit as 15 minutes and pro-rates the time units so they actually pay to the minute. For commercial carrier contracts this could a negotiable point. Make sure your billing program has the capability to bill in this fashion. We had a PPO contract that recognized 10 minute time units after 4 hours of anesthesia (excluding OB). Of course, we had to appeal every charge for underpayment which we gladly did and eventually received appropriate payment. Sadly, this contract went away when the payer was acquired by a larger company that did not acknowlege this time unit exception.

I have attached the CMS Chapter 12 (Anesthesia) Guideline. See section
50 Subsection G.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Julie, CPC
 
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