Anesthesia and Pain Management

October 31st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS

Categories: Anesthesia|Pain Management Modifiers Office of Inspector General (OIG)

Anesthesia and Pain management is under close watch from the OIG according to a report from Anesthesia Business consultants, they stated, "The Health and Human Services Office of Inspector General (HHS OIG) reports in its most recent Semi-annual Report to Congress that in FY 2017 it brought criminal actions against 881 individuals or organizations engaging in crimes against HHS programs and their beneficiaries, and an additional 826 civil actions, including false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty settlements and administrative recoveries related to provider self-disclosure matters. OIG excluded 3,244 individuals and entities from participation in federal healthcare programs.”

This is not to mention the public health concern for chronic pain management and the growth of opioids prescribed. The CDC has developed and published guidelines for prescribing opioids for chronic pain to improve the way opioids are prescribed and hopes to reduce the number of patients who misuse or overdose with these drugs.

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Anesthesia Billing

Anesthesia is reimbursed for the most part on the amount of time spent providing patient care. Therefore, it is important to correctly record the Start-Stop Time in the medical record. When billing for anesthesia services, there is a formula used to determine the allowed time. Generally, the Anesthesia formula is as follows (Time Unit + Base Unit) X Conversion Factor = Allowed.

Prior to 2017 moderate sedation was indicated by a red bulls-eye on a CPT code that included moderate sedation. This was removed by the AMA in 2017 that affected over 700 codes. When using these codes moderate sedation needs to be coded separately.

Payment can also be made for anesthesia services with multiple procedures and is based on the procedure with the highest base unit value.

Modifiers for anesthesia billing identify specific situations and are required to report the type of provider that furnished the service. For example, an anesthesiologist can medically direct several cases at one time done by a qualified Non-physician anesthetist. If an anesthesiologist is medically supervising more than four concurrent anesthesia procedures the AD modifier is reported. The AA Modifier was the focus of the OIG Anesthesia investigations in 2015.

A few examples of modifiers are:

AA- Anesthesia Services performed personally by an anesthesiologist
AD – Medical supervision by a physician: more than four concurrent anesthesia procedures
QX - CRNA service: with medical direction by a physician

For Medicare, Claims processing see the CMS Manual Pub-100-04

Click Here for a great resource for an anesthesia guide from CMS Palmetto GBA.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

Reporting Modifiers 76 and 77 with Confidence
April 18th, 2023 - Aimee Wilcox

Modifiers are used to indicate that a procedure has been altered by a specific circumstance, so you can imagine how often modifiers are reported when billing medical services. There are modifiers that should only be applied to Evaluation and Management (E/M) service codes and modifiers used only with procedure codes. Modifiers 76 and 77 are used to identify times when either the same provider or a different provider repeated the same service on the same day and misapplication of these modifiers can result in claim denials.

Five Documentation Habits Providers Can Use Implement to Improve Evaluation & Management (E/M) Scoring
April 11th, 2023 - Aimee Wilcox

Provider education on E/M coding updates is vital to the success of any organization, but how do you whittle down the massive information into bite-sized pieces the providers can learn in just a few minutes? Check out the five steps we have identified to teach providers in just a few minutes that can significantly impact and improve coding outcomes.

Second Quarter 2023 Updates are Different This Year
April 6th, 2023 - Wyn Staheli

The second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023.

7 Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth Fraud
March 28th, 2023 - Aimee Wilcox

A recent review of telehealth services reported in Medicare claims data during the pandemic where these seven measures for identifying suspected fraud, waste, and abuse were applied, revealed more than a thousand Medicare providers potentially committed fraud during this period. What are the measures the OIG applied during their review, and how will that impact future telehealth guidelines moving forward?

MUEs and Bilateral Indicators
March 23rd, 2023 - Chris Woolstenhulme

MUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.

It is True the COVID-19 PHE is Expiring
March 16th, 2023 - Raquel Shumway

The COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.

Billing Process Flowchart
March 2nd, 2023 -

The Billing Process Flowchart (see Figure 1.1) helps outline the decision process for maintaining an effective billing process. This is only a suggested work plan and is used for demonstration purposes to illustrate areas which may need more attention in your practice’s policies and...