Archive December 2016 XVII, No. 12

Anesthesia Alert: Ever Wonder How Anesthesia Gets Paid?

A crash course in base units and 15-minute increments of time.

Mike MacKinnon

Mike MacKinnon, MSN, FNP-C, CRNA

BIO

how anesthesia is billed MEDICAL ECONOMICS Do you understand how anesthesia is billed?

Ever wonder how anesthesia providers are paid? Most of us are salaried or are paid hourly, but it's good for facility managers to know how the folks at the head of the table bill insurers for our services — and what factors make a facility a desirable place for us to work. Let's start with how anesthesia is billed: in base units and time units.

  • Base units. These are the numeric value attached to each CPT code. They cover the pre-operative interview, and generally factor in complexity and risk. Anesthesia for a laparoscopic cholecystectomy is valued at only 7 base units, while a coronary artery graft without cardiopulmonary bypass is valued at 25 base units.
  • Time units. These are generally in 15-minute increments. They start the moment a provider enters the OR and stop the moment he gives a report to the PACU nurse.

There are some exceptions, but generally, if a case has 6 base units and takes 60 minutes, you'd bill for a total of 10 units (6 base + 4 time). The ASA Relative Value Guide lists the number of base units for each case. Check the area of the body having the procedure and look under the list of codes. For example, cataract surgery falls under "procedures on the eye" and 00142 is anesthesia for lens surgery (4 base units plus time units).

Here are the factors an anesthesia group weighs when considering a contract's worth at your facility.

1Your payer mix. You might assume all lap choles pay the same. They don't. Nor can you assume that complex procedures involving very sick patients always pay more. Medicare pays much less than commercial insurance. A typical 10-unit case for a private payer might pay $500 ($50 per unit), but Medicare would likely pay only $220 (about $22 per unit). And the landscape can change. If, for example, a large employer closes, many patients in that area may shift from commercial insurance to Medicaid (or no insurance).

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