Choosing, Documenting, and Billing Various Types of Anesthesia Services

While medical necessity usually dictates what type of anesthesia service an anesthesiologist provides to a patient, understanding the distinctions of each type is important to keep in mind when documenting and billing for the service.

Here are a few tips to keep in mind when documenting and billing for various types of anesthesia services.

1. Make sure the patient understands what type of anesthesia he will receive and how that may change once he is in the surgical suite.

For a single procedure, patients may have multiple types of anesthesia, like a post-operative pain block administered under conscious sedation, followed by general anesthesia. Or the anesthesiologist may plan for monitored anesthesia care (MAC) but find they must transition to general anesthesia if the patient slips into a deeper level of unconsciousness. Still other patients may need only regional anesthesia, like an epidural during child labor.

Helping patients understand the different types of anesthesia and how those will be billed will help eliminate surprises once claims and statements are sent out. This could be as simple as providing the details of the type of anesthesia to the surgeon’s office or hospital staff who will be explaining the procedures to patients prior to surgery. It’s also important that your billing staff or billing company understand the various types of services as they are fielding billing and payment questions.

2. Know what to document for each type of anesthesia service.

For general anesthesia and MAC, start and stop times are required. For MAC and regional anesthesia, documentation of medical necessity often is required. Also, document all follow up visits after post-op pain blocks.

If you performed additional or ancillary procedures during anesthesia, like a Swan Ganz catheter or the insertion of central venous pressure lines, be sure to document those as well, as they can be billed separately from the anesthesia service.

Did you perform general anesthesia for procedures in more than one area? Be sure to document that, too. While you can’t bill anesthesia codes for each procedure, you can choose the code with the highest number of base units. Some anesthesia codes represent procedures that cover multiple areas and have higher base units.

Finally, document any conditions the patient has that complicate the anesthesia service. Not all payers will compensate for qualifying circumstances, but some will. Having that information in your documentation will make it possible to bill for them when available.

3. Review which anesthesia modifiers are required for each type of anesthesia.

Many anesthesia modifiers are specific to the person or persons providing the service, not the service itself:

AA – Anesthesia Services performed personally by the anesthesiologist;
AD – Medical Supervision by a physician; more than 4 concurrent anesthesia procedures;
QK – Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals;
QX – CRNA service; with medical direction by a physician;
QY – Medical direction of one certified registered nurse anesthetist by an anesthesiologist;
QZ – CRNA service: without medical direction by a physician; and
GC – these services have been performed by a resident under the direction of a teaching physician.

Other modifiers, however, are specifically related to MAC:

G8 – Monitored anesthesia care (MAC) for deep complex complicated, or markedly invasive surgical procedures;
G9 – Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition;
QS – Monitored anesthesia care service.

Also, modifiers are used to indicate qualifying circumstances, when payable or when used for informational purposes:

P1 – Healthy individual with minimal anesthesia risk.
P2 – Mild systemic disease.
P3 – Severe systemic disease with intermittent threat of morbidity or mortality.
P4 – Severe systemic illness with ongoing threat of morbidity or mortality.
P5 – Pre-morbid condition with high risk of demise unless procedural intervention is performed.

As well, certain post-operative pain blocks and other ancillary procedures require modifiers to indicate laterality or that they were performed separately from other services provided on the same day.

4. Know what type of anesthesia you are actually providing.

It may seem obvious to the anesthesiologist what type of service she is providing, but the boundaries between the types sometimes get blurred through variation in standards and practices. For instance, post-operative pain blocks are different than regional anesthesia, though both might include an epidural or spinal block. Moderate or (conscious) sedation might be part of MAC, but MAC includes more than just the administration of sedative and/or analgesic medications. In fact, sometimes MAC more closely resembles general anesthesia. Be mindful of the blurring of these lines as you talk with patients, perform the service, and then document and bill these procedures.