Anesthesia billing basic

Concurrent Medically Directed Anesthesia Procedures

by Niels
Concurrent Medically Directed Procedures Concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether the other procedures overlap each other. Concurrency is not dependent on each of the cases involving a Medicare patient. For example, if an anesthesiologist directs ... Read More

Conscious Sedation and Deep Sedation

by Niels
Conscious Sedation The intent of conscious sedation is for the patient to remain conscious and able to communicate during the entire procedure. The patient retains the ability to independently and continuously maintain a patent airway and respond appropriately to physical stimulation and/or verbal command. Conscious sedation includes performance and documentation of pre- and post sedation ... Read More

Monitored Anesthesia Care (MAC)

by Niels
Monitored anesthesia care is a specific anesthesia service in which an anesthesiologist or CRNA has been requested to participate in the care of a patient undergoing a diagnostic or therapeutic procedure. Monitored anesthesia care includes all aspects of anesthesia care: a pre-procedure visit, intraprocedure care and postprocedure anesthesia management. During monitored anesthesia care, the anesthesiologist ... Read More

Pre and post anesthetic service and eligible providers

by Niels
Pre-anesthetic Evaluations and Post-operative Visits MHCP uses the CMS list of base values, which were adopted from the relative base values established by the ASA. The base value for anesthesia services includes usual pre-operative and post-operative visits. No separate payment is allowed for the pre-anesthetic evaluation regardless of when it occurs unless the recipient is ... Read More

Anesthesia provider types

by Niels
Anesthesiology: The practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery.  Anesthesiologist: A physician who specializes in anesthesiology and is board certified as an anesthesiologist.  Certified Registered Nurse Anesthetist (CRNA): An advance practice registered nurse. CRNAs are registered nurses with a baccalaureate degree ... Read More

How payment calculated for Anesthesia service?

by Niels
Payment Rules The fee schedule allowance for anesthesia services is based on a calculation that includes the anesthesia base units assigned to each anesthesia code, the anesthesia time involved, and appropriate area conversion factor. The following formulas are used to determine payment: • Participating Physician not Medically Directing (Modifier AA) (Base Units + Time Units) ... Read More

What is base unit and Time unit

by Niels
Base Units Each anesthesia code (procedure codes 00100-01999) is assigned a base unit value by the American Society of Anesthesiologists (ASA) and used for the purpose of establishing fee schedule allowances.Anesthesia services are paid on the basis of a relative value system, which include both base and actual time units. Base units take into account ... Read More

Anesthesia provider reimbursement

by Niels
Payment at Personally Performed Rate The fee schedule payment for a personally performed procedure is based on the full base unit and one time unit per 15 minutes of service if the physician personally performed the entire procedure. Modifier AA is appropriate when services are personally performed. Payment at Medically Directed Rate When the physician ... Read More

What is Monitored Anesthesia Care?

by Niels
Monitored anesthesia care involves intraoperative monitoring by a physician or qualified individual under the medical direction of a physician or of the patient’s vital physiological signs in the anticipation of the need for administration of general anesthesia or of the development of adverse physiological patient reaction to the surgical procedure. It also includes the performance ... Read More

Anesthesia Services and Teaching Anesthesiologist

by Niels
If a teaching anesthesiologist is involved in a single procedure with one resident, the anesthesia services will be paid at the personally performed rate. The teaching physician must document in the medical records that he or she was present during all critical (or key) portions of the procedure. The teaching physician’s physical presence during only ... Read More