Anesthesia Billing Services

Each anesthesia code carries base units reflecting the complexity of the procedure. Time is added on top: anesthesia time starts when the anesthesia provider begins preparing the patient for anesthesia and ends when the patient can safely be handed over to postoperative care, and Medicare converts the minutes reported on the claim into 15-minute units. Commercial contracts can count time differently and may pay extra units that Medicare does not.

The total is multiplied by a conversion factor. Medicare publishes anesthesia conversion factors by locality and updates them every year, and commercial contracts set their own. Because these figures change annually, we track the current values for each payer and locality rather than quoting them, and use them to check that every payment matches the contract.

The care team model decides the split. A case personally performed by an anesthesiologist is billed differently from one where an anesthesiologist medically directs CRNAs, and medical direction is only allowed when specific required steps are met and documented and the number of concurrent cases stays within the limit. One missing attestation can reduce payment on every case that day.

Official source: CMS: Anesthesiologists Information Center (external site)

Regional blocks are billed differently depending on why they were done. When a block is the primary anesthetic, it is billed as anesthesia time under the anesthesia code. When the surgeon requests a separate block for post-operative pain and general anesthesia is the primary technique, the block may be billed as its own procedure, with documentation of the surgeon's request.

In ambulatory surgery centers and hospitals, the facility bills its own fee and the anesthesia group bills the professional service separately. Each facility has its own scheduling and record systems, so we set up record capture per facility to make sure every case, including short endoscopy and pain cases, reaches billing.