Wiki Anesthesia relief providers/charge submission

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JGGBALLEN

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Hello Everyone and thank you in advance for any education and guidance you can provide

Based upon an article I read; via AAPC Blog..."Bill the case either under the name of the physician who spent the most time with the patient or under the name of the physician who started the case."

This is the documented scenario:
Primary AA/CRNA: AnesStart 12:28/OpStart 13:02/OPEnd 15:20/AnesEnd 15:29
Relief AA/CRNA: Start 13:18 to End 13:24

Q1. In this scenario the Primary AA/CRNA (181 minutes @ 12.1 TIME UNITS) represents longest time & started the case...correct?

Q2. I also presume from the above statement, that the relief provider's documented time is NOT CAPTURED and/or SUBMITTED as a charge?

Q3. Or, do we at any point deduct the relief providers time from the primary provider total time?

Q4a. Is there any scenario where the lesser relief providers time can/should be submitted?
Q4b. OR, is that considered "double dipping"?

Q5. if Q4 it is possible, would the BASE + ASA unit be included along with the TIME?
I have seen same end times documented by the primary and relief (although relief provider total time is less); in which case I will submit as noted above

Q6. But, when both relief & primary start & end times are the same...how is that handled?

Q7. And would that be a scenario where relief TIME + BASE + ASA be submitted along with primary total units...creating a two line charge entry?

Q8. My understanding is that the 99100-99140 & ASA (P1-P6) are NOT payable by Medicare. If it is the primary and I know there is a secondary can I still submit those elements and; it not be consider fraud (knowingly); as I will need for the secondary payer?

Thank you so much for assisting me in understanding this specialty
 
I'm studying anesthesia guidelines to prepare for an coding test next week for a new job. From what I've read, and hopefully understood, when a relief provider is required the combined time is billed just as there was only one provider. The criteria for which provider is the billing provider depends on if it is a teaching case of not.

Teaching cases: Always billed as the provider who started, regardless of the fact that the relief provider may have spent a longer period of time in the case.
Non-teaching cases: Always bill under the name of the provider who spent the greater amount of time.

That said, always default to specific payer guidelines, if in doubt call the payer and ask. (ounce of prevention...)

My understanding of the physical status modifiers is that they are informational only and that submitting them to payers that don't want them (including Medicare), will result in front-end rejections causing delays in payment.

I don't know of any reason Medicare wouldn't pay the add-on codes 99100 - 99140, as long as they aren't billed alone and they are linked to a diagnosis that demonstrates medical necessity.

I'm hoping an experienced anesthesia coder will provide some insight for us newbies.

Tammy
 
ddewitt

I have a question; regarding times when they are late at night, ex:

Start time: 23:48
End Time: 00:17

Now my physician is stating I should bill the later date of end of procedure, I say wrong, starts with the "start time date"

They are not wanting to change the "dates" in the records to support. I am not going down with that,

Can you all confirm my correct?

Ex: Date is 4/13 Start time
End date: 4/14,

I bill 4/13.

Please let me know
 
You bill the full time under the md with the most time. And as far as time that passes into the next day... you use only the start date
 
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