Anesthesia Billing question

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cuden

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Hello,

During residency, I was taught that anesthesia time starts when the anesthesiologist gets in the OR to begin the case and therefore, most of the time, anesthesia start time is the same as OR start time. Now, in private practice, I notice that some anesthesiologists put their anesthesia start time as the time when they encounter the patient in the holding area which could be 30 minutes prior to OR start time. Is this practice acceptable or "legal"?

Thank you

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I'm certainly no expert, but I assumed Anesthesia time was from the moment you leave pre-op to when you have given report/ left PACU. That encompasses the time for which the anesthesia team is the primary caregiver.

Be interested to hear other interpretations.
 
I would say that like just about everything else in medicine, the answer is "It depends." I am far from an expert. I would recommend checking with your billing person to be certain.

Since that is not what you want to hear, I'll tell you what I did in residency, which is basically the same as what I do now as an attending.

If you are performing a procedure in pre-op such as a block, you bill as discontinuous time. Ex: I roll the patient into the block room at 0700 and finish the block at 0715. The patient then rolls into the OR at 0730, and that is a new start time.

If I give benzos/narcotics, etc. in the pre-op area and monitor the patient significantly before rolling back to the OR, I put the start time as when I give the meds. If it's just giving some Versed as you roll back, I put start time as when I enter the OR.

If I am doing nothing special in pre-op, I put start time as when I enter the OR.

Stop time is always when I finish settling the patient in PACU/ICU and have given report. If there is a delay in giving report (ex: vent was supposed to be setup, but wasn't), it is still anesthesia time (because I haven't transferred care yet) and I continue to chart vitals on our intraoperative record.
 
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I would say that like just about everything else in medicine, the answer is "It depends." I am far from an expert. I would recommend checking with your billing person to be certain.

Since that is not what you want to hear, I'll tell you what I did in residency, which is basically the same as what I do now as an attending.

If you are performing a procedure in pre-op such as a block, you bill as discontinuous time. Ex: I roll the patient into the block room at 0700 and finish the block at 0715. The patient then rolls into the OR at 0730, and that is a new start time.

If I give benzos/narcotics, etc. in the pre-op area and monitor the patient significantly before rolling back to the OR, I put the start time as when I give the meds. If it's just giving some Versed as you roll back, I put start time as when I enter the OR.

If I am doing nothing special in pre-op, I put start time as when I enter the OR.

Stop time is always when I finish settling the patient in PACU/ICU and have given report. If there is a delay in giving report (ex: vent was supposed to be setup, but wasn't), it is still anesthesia time (because I haven't transferred care yet) and I continue to chart vitals on our intraoperative record.

This is what I do. Just to add to that... if you are doing a block in the OR. Start time starts AFTER you are done doing the block (unless the block is done under GA).
 
I document the time I start talking to the patient, and the time we enter the OR.

I have no idea what the billing people do with those numbers, but it seems like we ought to get paid for every second of our lives we spend with the patient.
 
Right, not supposed to bill for time when you block in preop. I used to block in the OR to capture time--and it was more efficient too, but understand that is a no-no now. My time starts when I take responsibility for the patient. My time ends after I sign off to PACU or ICU professionals. I don't care about in the room out of room time except to keep the surgeons, administrators happy
 
A standard preop is bundled in with the start up units.

You are allowed to bill for reasonable time to prepare the patient for the anesthetic (starting the IV, drawing up drugs, etc)

If you are billing the patient for the block for post op pain control, you cannot bill for the time units.

To be safe I start anesthesia time at OR room time. You cannot bill from the time you preop until OR room time unless you are prepping the patient in some way. Just because the OR nurse takes 30 minutes to get the patient back to the room doesn't mean you can bill for it.

I work in an ambulatory practice. If I was hospital based and had to go to the ICU and prepare the patient for transport and then monitor during transport, I would bill for that time.

Anesthesia stop time is when the patient's care has been transferred to the PACU. Most people see this as 5-10 minutes.
 
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I would say that like just about everything else in medicine, the answer is "It depends." I am far from an expert. I would recommend checking with your billing person to be certain.

Since that is not what you want to hear, I'll tell you what I did in residency, which is basically the same as what I do now as an attending.

If you are performing a procedure in pre-op such as a block, you bill as discontinuous time. Ex: I roll the patient into the block room at 0700 and finish the block at 0715. The patient then rolls into the OR at 0730, and that is a new start time.

If I give benzos/narcotics, etc. in the pre-op area and monitor the patient significantly before rolling back to the OR, I put the start time as when I give the meds. If it's just giving some Versed as you roll back, I put start time as when I enter the OR.

If I am doing nothing special in pre-op, I put start time as when I enter the OR.

Stop time is always when I finish settling the patient in PACU/ICU and have given report. If there is a delay in giving report (ex: vent was supposed to be setup, but wasn't), it is still anesthesia time (because I haven't transferred care yet) and I continue to chart vitals on our intraoperative record.

Excellent explanation.

To the OP - simply adding 30 minutes for a pre-op evaluation is just begging for a Medicare/insurance fraud investigation, which you will LOSE. Your group is absolutely foolish to do this. You may think nobody is paying attention, but all it takes is one pissed off RN or an anesthetist that's concerned about being implicated along with you and blows the whistle, or perhaps an astute claims reviewer, and you're absolutely totally screwed. Every single occurrence is a count of fraud. Do you really want to pay back TRIPLE damages and face potential criminal liability for knowingly committing fraud? Thirty minutes of time is 2-3 units depending on your payor. Even at $20/unit, that adds up quickly if you're doing this on every patient every day.
 
Hello all:

Thank you everyone for your input. I think I will just stick to what I was taught during residency: anesthesia start time = OR in room time
 
I agree with Dr Gill mostly but I will add, Do not trust the response of your billing person alone . DO your own research. It's you that will have to explain down the road, refund etc.
Base units are designed to include the day of surgery assessment. So you walk up to the pt. say hi I am Dr.A , you took your bp pill held your insulin, have no C/P etc. blah blah blah, deep breath, open mouth, we are planning GA , any questions??? ...if room is ready and you are going to start walking/wheeling back start the clock now. If after the above, you give MDZ and place an Aline- you can start the clock in pre-op after pushing the drug- just chart the vitals/drug on the record. If you give MDZand do a Fem N. block in pre-op/OR , back out the time for the block, because they are paying you 6 or 8 units for the block- no matter how long it takes. I can't answer whether a pre-op line under sedation is billable for time?
So your initial question of starting 30 mins before entering the room after "saying hello"-that is not cool. In ambulatory if that segment is 3 mins I see no problem. End time is after giving report to Pacu, you say ,any questions? ,bye bye = end time . Walk over to next Pt., repeat. If I do 5 EGD's in a row with a quick surgeon , my stop > start of the next case can be as little as X mins.. 50 ft. walk from pacu to preop.
Pre-op eval done another day prior to surgery is another consult code and OK , except in alot of outPt. work you never get the chance. I've seen 2 local places hit Pt's with that consult code same day, = fraud. This year MCR did change an ASC rule allowing surgical eval and surgery to occur on same day, so how could we get a chance to do a pre op "consult" another day- maybe they'll change the rule. I never get the chance to do pre-op consults in ASC. Now what may be MCR fraud may not be wrong when billing ie. "Pipefitters local 102 Union " a non contracted private insurer.
 
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