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Thread: Anesthesia coding

  1. #1

    Default Anesthesia coding

    AAPC: CPC Promo
    Hello fellow members!
    I'm trying to brushup on my anesthesia coding, and can't remember how the formula goes. I know its coded in 15 min increments. Can someone briefly tell me how the formula goes, and where I get the base units from? I know I'm suppose to use a qualifying circumstance and a physical circumstance, which each has a base unit value, and then for the actual anesthesia code, am I suppose to check on the CMS list for the unit value and then add all of those up? If all of this is correct, what do I do after this? Also, where do I get the base unit values for the physical status modifiers and the qualifying circumstances.
    Thanks

  2. #2
    Join Date
    Apr 2007
    Posts
    1,478

    Default

    For Medicare billing or carriers that follow the same style of reporting, you would report the anesthesia code, appropriate modifier(s) AA QY QK QX QK QS and in the units field on the CMS 1500 the total minutes of the case. You would also provide the start and end times such as Start 13 40 End 15 40 in box 19 or electronic corresponding section. The formula that involves the conversion factor and base units is to review the potential reimbursement or verify the allowable on the explantation of benefits looks accurate and does not involve the actual creation of the claim/charge.

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

    page 123

    Anesthesia Time and Calculation of Anesthesia Time Units
    Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished on or after January 1, 2000, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption.
    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.
    For purposes of this section, anesthesia practitioner means a physician who performs the anesthesia service alone, a CRNA who is not medically directed, or a CRNA or AA, who is medically directed. The physician who medically directs the CRNA or AA would ordinarily report the same time as the CRNA or AA reports for the CRNA service.

  3. #3

    Default Anesthesia

    That's a mouth full you wrote. So, basically, are you saying I don't have to use the formula unless I want to check the pricing?


  4. #4
    Join Date
    Apr 2007
    Posts
    1,478

    Default

    Yes, for pricing.

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