The 2019 edition of the Relative Value Guide (RVG) used for anesthesia coding and billing includes an updated definition of anesthesia time.
The new definition brings the RVG in line with the updated Medicare Claims Processing Manual, Chapter 12, Section 50G, which also has a new definition of anesthesia time as of November 28, 2018.
2018 RVG: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia care in the operating room or in an equivalent area, and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient is safely placed under post-anesthesia supervision.
2019 RVG: 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 is safely placed 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, 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.
The primary reason for the update is to reflect the inclusion of discontinuous time in the total time calculation, which CMS and many private payers allow. Discontinuous time occurs when the anesthesiologist is temporarily not in attendance after anesthesia services have begun, but it cannot be used once the surgical procedure is underway. As well, if separately billable procedures, like nerve blocks, are performed before anesthesia is begun, the time spent on the procedure should not be included in the anesthesia time.
According to a recent American Society of Anesthesiologists’ Timely Topics article, while the new definition doesn’t change how time is already being calculated, “The revised definition is intended to educate and ensure that all anesthesiologists and their respective anesthesiology practices are aware of this option and how to properly and compliantly make use of it.”
One slight difference between the new CMS and RVG anesthesia time definitions is the phrase “is safely placed” (in the RVB definition) versus “may be safely placed” (in the CMS) definition. According to the ASA, “is safely placed” is an intentional wording that’s been part of the RVG definition for more than a decade.
“This distinction between ‘is safely placed and ‘may be placed safely’ first appeared in the 2007 edition of the RVG to address PACU back-ups when the patient could be safely transferred, but the anesthesiologist had to stay with the patient and provide postoperative care because the PACU could not accept the patient,” writes Peter DeSocio, M.D., M.B.A., FASA, and Vijay Saluja, M.D., M.B.A, FASA.
For more information about the new RVG definition of anesthesia time, check out the ASA Timely Topics article, “2019 Relative Value Guide Updates Include Anesthesia Time and Field Avoidance.”
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