Anesthesia Fees

Note Due to AMA copyright on CPT, you must be a registered user: either on free trial, Advanced or Standard subscription based - to use this part of the ICD10Doc application

Watch a short YouTube movie and see how easy it is to calculate the Anesthesia Fees with ICD10Doc.

1. Find a CPT code related to Anesthesia, with the search or reverse search functions on the Home page. The result will show in its own box as CPT / HCPCS.



Click on the link that you'd like to continue with.



2. The next screen asks for the region - in order to match the correct Medicare carrier for reimbursement. From the drop down menu pick the region for your caculation purposes and then click on the big blue button to calculate the fees.



3a. Now you may be on a page which at the bottom has a big blue button - Calculate Anesthesia Fees.
Enter the Time Units and Modifying units and click on this button. Results are Anesthesia related.



...and the result will show on the left side of the page:



3b. If on the other hand, the CPT code is NOT an Anesthesia code, the page after picking the region will show NON Anesthesia Fees related information and it will have no mechanisms to enter the Time Units and Modifying units. It is just NOT an anesthesia CPT code. Please see the Anesthesia Corsswalk section below.

Anesthesia Crosswalk

Note Due to AMA and ASA copyright on CPT and the crosswalk, you must be a registered user: either on free trial or subscription based - to use this part of the ICD10Doc application

Watch a short YouTube movie and see how easy it is to crosswalk between anesthesia and surgery codes with ICD10Doc.

1. Find a CPT code, with the search or reverse search functions on the Home page.



The result will show in its own box as CPT / HCPCS. Click on the link that you'd like to continue with.



2. Scroll almost to the bottom of the next screen, to the Anesthesia Crosswalk box.
If the code selected is a Surgical code, ICD10Doc will crosswalk to the Anesthesia related CPT codes that may be submitted with the Surgical code.



The next page will ask for the region and Medicare carrier in order to calculate the correct fees.



If the code selected is an Anesthesia code (see above), ICD10Doc will crosswalk to the Surgical related CPT codes that may be submitted with the Anesthesia code.
The Anesthesia Crosswalk is bidirectional: from an Anesthesia CPT code to a Surgical CPT code and vice versa.

Background

How to determine the Anesthesia Fees:
. Determine the appropriate CPT code(s) for the surgical procedure(s) performed and then with the Anesthesia Crosswalk set the appropriate ASA code.
. The ASA code will determine the number of base units.
. Set the appropriate number of time units.
. Assign the appropriate physical status modifier, modifier to identify MAC services
. Set the appropriate modifying units.
. Determine the total units for the anesthesia services

The general formula for calculating anesthesia charges is as follows:

(Base units + Time units + Modifying units) x Conversion factor = Anesthesia fees

Base units
Each anesthesia CPT code has a base unit value. The Base units are published once a year by CMS.
The base unit value is reflective of the difficulty and skill required for the procedure.
Crosswalk all surgical procedures performed and pick the anesthesia code with the highest base units value - that is best describing the anesthetic services provided.
Only one anesthesia code is reported

Time Units = Total Minutes of Service/15
Begins: When the anesthesia provider prepares the patient for the induction of anesthesia in the operating room or equivalent area
Ends: When the anesthesia provider is no longer in personal attendance (patient is safely placed under post-operative supervision)
A "Time Unit" is a measure of each 15-minute interval, or fraction thereof, during which anesthesiology services are performed.
This value must be calculated based upon the length of time spent by the provider rendering the service.
AMA and ASA recommend that 1 unit of time is equal to 15 minutes of anesthesia time
Time is rounded up to the next unit after 7 ½ minutes is reached or it may be submitted as a decimal like 3.6
Refer to your local payer contracts and policies for specific guidance for reporting time.
Note: Not all carriers accept rounding the Time Unit or a fraction of Time Unit. Check with you local carrier if time units such as 3.6 are accepted and what are the rounding rules.

Modifying Units
Modifying units such as ASA Physical Status, Age, Position, Additional Circumstances, Lines and etc. may or may not be accepted by you local carrier.
Note: Not all carriers accept Modifying Units. Check with you local carrier the details of the accepted Modifying Units.

Conversion Factor
The Conversion Factor is specific to each carrier and location and it is published once a year by CMS.

For more information on Anesthesia Fee visit the Anesthesiologists Center at CMS web site
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