Anesthesia start time

[anbuitachi]

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Inaccurately recording the start of anesthesia care results in lost billing time for medical centers

Inaccurately recording the start of anesthesia care during a procedure is common and results in significant lost billing time for anesthesia practices and medical centers, suggests a study being presented at the American Society of Anesthesiologists' ADVANCE 2023, the Anesthesiology Business Event.

www.news-medical.net

Incorrectly recorded anesthesia start times cost medical centers and anesthesia practices significant revenue

Inaccurately recording the start of anesthesia care during a procedure is common and results in significant lost billing time for anesthesia practices and medical centers, suggests a study being presented at the American Society of Anesthesiologists’ ADVANCE 2023, the Anesthesiology Business Event.

www.asahq.org

 

[coffeebythelake]

First thing when patient enters the OR

And hit the stop time when returning to the OR after dropping off patient in PACU, signing out to the nurse, and ensuring patient is stable and immediate needs met

 

[anbuitachi]

Are people actually frequently giving premeds in pre-op and attaching monitors? Article says they used 2 mins to calculate... I understand if you premed and monitor for blocks or something but to do it in pre-op just for pre med and monitoring??? Seems excessive

 

[Beeftenderloin]

I squirt some midaz or fent in the IV in preop as we’re rolling back around 50% of the time. If I do, that’s my anesthesia start time. I’ve provided some anesthesia and I'm monitoring them, usually in the form of small talk that tells me their airway remains patent and they are able to ventilate. That plus the walk to the room typically adds 2-3 mins to my billing time.

If I didn’t give anything in pre-op then room time = anesthesia start time.

 

[nimbus]

We don’t roll the patient back so room time is anesthesia start time.

Even if we sedate and block in preop, we usually leave the patient’s side after the block so that is not anesthesia time. Also time spent doing postop pain blocks cannot be billed as anesthesia time. Even after the patient enters the room, we deduct 1-2min if we do a preinduction Aline.

If we do lines or blocks postinduction (eg CVL or a TAP or ESPB) we count that as anesthesia time.

 

[vector2]

we deduct 1-2min if we do a preinduction Aline.

If you're continuously with the patient and monitoring them in the OR while you do the a-line then why is this not also anesthesia time?

 

[nimbus]

If you're continuously with the patient and monitoring them in the OR while you do the a-line then why is this not also anesthesia time?

Not exactly sure. I think our group is being extra conservative since lines and blocks are billed separately. I personally think your point is reasonable that there should be no billing difference whether the Aline is placed after IV sedation or after induction of GA.

 

[vector2]

Not exactly sure. I think our group is being extra conservative since lines and blocks are billed separately.

Interesting. I was always under the impression that even though lines are billed separately from base/time units, they could still be done during anesthesia time (unlike say postop blocks).

 

[thinkorswim]

Interesting. I was always under the impression that even though lines are billed separately from base/time units, they could still be done during anesthesia time (unlike say postop blocks).

If this were the case with blocks then every interventional pain physician would be billing for anesthesia services as well.

 

[potcake76]

See attached chart re block placement and anesthesia time billing.

 

[nimbus]

See attached chart re block placement and anesthesia time billing.

Those are the same rules we follow. If the block is the primary anesthetic, we can bill for time it takes to place the block but cannot bill the block separately for postop pain. We can also bill ultrasound guidance separately regardless of whether the block is the primary anesthetic or for postop pain. If we place a block postinduction and prior to emergence (most fascial plane blocks) we count the time as anesthesia time. If it’s preinduction or post-emergence, we do not count the time.

 

[UscGhost]

Anesthesia start time begins when continuous care of the patient begins, per CMS. If you are giving a sedative and transporting the patient to the OR...that's continuous care and anesthesia start time is BEFORE in OR.

Same applies to after leaving OR and getting to pacu.

Not sure why anyone would voluntarily short change themselves.

 

[UscGhost]

If this were the case with blocks then every interventional pain physician would be billing for anesthesia services as well.

The pain docs aren't providing sedation and monitoring while placing their blocks. The nurse in the room is providing that service.

If you perform a block while under anesthesia, like a TAP block, the. You can bill for both anesthesia time and block.

Same with lines

 

[2Fast2Des]

Anesthesia start time begins when continuous care of the patient begins, per CMS. If you are giving a sedative and transporting the patient to the OR...that's continuous care and anesthesia start time is BEFORE in OR.

Same applies to after leaving OR and getting to pacu.

Not sure why anyone would voluntarily short change themselves.

My group leadership felt that people would take advantage and "slow" roll the pt to the OR if the pre evaluation and versed time is a start time to increase the billable time. So they mandated it to in room time as anesthesia start time.

I don't do versed anyway... Except for blocks. Why is that a thing? I just chit chat with them and keep them distracted, unless they are really and anxious and wigging out.

 

[UscGhost]

My group leadership felt that people would take advantage and "slow" roll the pt to the OR if the pre evaluation and versed time is a start time to increase the billable time. So they mandated it to in room time as anesthesia start time.

I don't do versed anyway... Except for blocks. Why is that a thing? I just chit chat with them and keep them distracted, unless they are really and anxious and wigging out.

Anxiolysis and anti-emetic

I would be pissed if my group didn't pay for the time I spend transporting a sick patient to and from the ICU. Especially when insurance pays for it as it's legitimate billable time.

Groups can just limit it to a maximum of 10 mins if they want to avoid abuse. Slow wake-ups are more abused than long start times anyway.

Otherwise it's just a self imposed pay cut

 

[coffeebythelake]

Anxiolysis and anti-emetic

I would be pissed if my group didn't pay for the time I spend transporting a sick patient to and from the ICU. Especially when insurance pays for it as it's legitimate billable time.

Groups can just limit it to a maximum of 10 mins if they want to avoid abuse. Slow wake-ups are more abused than long start times anyway.

Otherwise it's just a self imposed pay cut

Matters more if you are not hospital employed.

 

[nimbus]

Anxiolysis and anti-emetic

I would be pissed if my group didn't pay for the time I spend transporting a sick patient to and from the ICU. Especially when insurance pays for it as it's legitimate billable time.

Groups can just limit it to a maximum of 10 mins if they want to avoid abuse. Slow wake-ups are more abused than long start times anyway.

Otherwise it's just a self imposed pay cut

We actually get paid for ICU pack up and transport time. That is different than patients coming from preop holding. We don’t roll those patients back, the circulators do. I say hello and then go to the lounge to eat some chips and catch up on foxnews.

When I first joined the group over 20 years ago, some people at another site would start their own IVs in preop, maybe give a little versed, and remain at the patient’s bedside chatting with them until the room was ready. I doubt the patients knew they were being billed for the talk time. Then they would help the nurses roll back. This would routinely pad anesthesia time by 20-30min. That was stopped.

 

[coffeebythelake]

We were told not to put our stop time on 5 or 0 (e.g. 915 am or 920 am) because it looked like we were rounding up our times. I think the concern for impropriety and possibly being accused of billing fraud is much greater than the concern for billing an extra 2 or 3 minutes of time.. even if a few minutes here and there does add up in a huge hospital system

 

[2Fast2Des]

Anxiolysis and anti-emetic

I would be pissed if my group didn't pay for the time I spend transporting a sick patient to and from the ICU. Especially when insurance pays for it as it's legitimate billable time.

Groups can just limit it to a maximum of 10 mins if they want to avoid abuse. Slow wake-ups are more abused than long start times anyway.

Otherwise it's just a self imposed pay cut

Logging into the pre-op pyxis, fighting the fingerprint scanner to read my prints, forgetting the pts name, run back to chart to find it, misspelling it on the wacky keyboard, getting the versed out from the pre-op pyxis, counting the 20ish vials to make sure the count is correct before taking it out, closing the cover, then pyxis giving error and opens drawer again because I didn't slam it hard enough. Then find the cart to get syringe and needle, drawing it up, giving it, all with no unit reimbursement for my work, not worth it 😂. I can get to the room 3 minutes quicker bypassing all that and save time in efficiency. Distraction chit chat with pt is the best anxiolytic, tried and true. Also makes for quicker wake up, so go home from the ASC sooner.

 

[UscGhost]

We actually get paid for ICU pack up and transport time. That is different than patients coming from preop holding. We don’t roll those patients back, the circulators do. I say hello and then go to the lounge to eat some chips and catch up on foxnews.

When I first joined the group over 20 years ago, some people at another site would start their own IVs in preop, maybe give a little versed, and remain at the patient’s bedside chatting with them until the room was ready. I doubt the patients knew they were being billed for the talk time. Then they would help the nurses roll back. This would routinely pad anesthesia time by 20-30min. That was stopped.

Yea if the nurses roll back for you, then it's not continuous presence so you cannot bill, as you said.

 

[UscGhost]

We were told not to put our stop time on 5 or 0 (e.g. 915 am or 920 am) because it looked like we were rounding up our times. I think the concern for impropriety and possibly being accused of billing fraud is much greater than the concern for billing an extra 2 or 3 minutes of time.. even if a few minutes here and there does add up in a huge hospital system

Yea that's just under billing. It adds up fast. Easily 1 unit missed per case, so of you are doing 5 cases a day, missing out on $200-250 per day in legitimate revenue. Cuts your effective unit rate 10%

If you are there, it's legitimate. People only got trouble back in the day because of overlapping times.

And yes, don't round up but that's easy to avoid. Just be accurate

 

[abolt18]

My anesthesia start time begins when I assume care for the patient whether or not I give them drugs. If I'm pushing them to the OR from pre-op or the ICU, I start my time at the time I start disconnecting the patient from monitors or untangling lines so I can transport.

If my start or end time is on a zero or a 5, I don't care. I just document the correct time, whatever it is. Statistically, you should end in a 0 or a 5 20% of the time... If you don't, I'd assume you're making stuff up.

 

[linkin06]

What do you do for start time when they wheel patient into room and we sit there waiting for the GI doc for eternity. I told them not to until they know doc is here.

 

[coffeebythelake]

My anesthesia start time begins when I assume care for the patient whether or not I give them drugs. If I'm pushing them to the OR from pre-op or the ICU, I start my time at the time I start disconnecting the patient from monitors or untangling lines so I can transport.

If my start or end time is on a zero or a 5, I don't care. I just document the correct time, whatever it is. Statistically, you should end in a 0 or a 5 20% of the time... If you don't, I'd assume you're making stuff up.

Should the end time be put in when you walk back to the OR to finalize the case? Your continuous patient care stops after youve transferred care to the PACU. Seems like returning drugs and finalizing charting would add up extra minutes that more than make up for putting start time as the in-OR time.

 

[UscGhost]

Technically speaking...your time ends once you leave the patients bedside. So you can't bill if you are somewhere else doing charting.

The advantage of paper charts is that you can do it while watching the patient in pacu.

 

[potcake76]

What do you do for start time when they wheel patient into room and we sit there waiting for the GI doc for eternity. I told them not to until they know doc is here.

If you administered any sort of anesthetic or gave Versed, you can bill for all time in which you were continuously with the patient. But you can’t bill for hanging out/chit chatting with a wide awake patient that you’re not providing actual care for.

 

[Drwine]

If you administered any sort of anesthetic or gave Versed, you can bill for all time in which you were continuously with the patient. But you can’t bill for hanging out/chit chatting with a wide awake patient that you’re not providing actual care for.

You also can't go 15 minutes without recording a vital sign on the chart.

 

[Beeftenderloin]

What do you do for start time when they wheel patient into room and we sit there waiting for the GI doc for eternity. I told them not to until they know doc is here.

Bill. If I have to sit there in the room, with a patient, I’m getting paid. Monitored anesthesia care says nothing about requiring administration of medications.

 

[jwk]

What do you do for start time when they wheel patient into room and we sit there waiting for the GI doc for eternity. I told them not to until they know doc is here.

We have this problem frequently with a couple GI guys. With the chronic offenders, I don't even go in the room, and wait for them to call me that they're ready. From the moment I walk in the room, I'm charging.

I have also charted "discontinuous time". In the room for 10 minutes - no doc? - write a note about "delay for presence of proceduralist" and sign off, head for the lounge, then sign back in when they're ready to go, which I won't do until the doc is standing in the room.

Should the end time be put in when you walk back to the OR to finalize the case? Your continuous patient care stops after youve transferred care to the PACU. Seems like returning drugs and finalizing charting would add up extra minutes that more than make up for putting start time as the in-OR time.

The definition for end time is well defined, and our previous corporate billing folks were sticklers for it. It's when you transfer care to the next provider, typically PACU or ICU RN. If I have to spend 20 minutes in PACU with a less-than-optimal patient, all that time is chargeable until I have dealt with the patient's issues, charted VS, and signed off. The hand-off time and end anesthesia time should be the same. We have rolling computers in our PACUs - there's no reason to go back to the OR computer to finalize a case. One of the few things I like about Cerner is that I can chart anywhere in the hospital that has a computer.

 

[abolt18]

Should the end time be put in when you walk back to the OR to finalize the case? Your continuous patient care stops after youve transferred care to the PACU. Seems like returning drugs and finalizing charting would add up extra minutes that more than make up for putting start time as the in-OR time.

I look at my watch when I finish handoff to the PACU nurse, then walk to the OR and back up the end time to that time I left the patient in PACU.

 

[UscGhost]

Bill. If I have to sit there in the room, with a patient, I’m getting paid. Monitored anesthesia care says nothing about requiring administration of medications.

Exactly this