Anesthesiology Billing Companies know that when factoring in modifiers and using add on codes are major conversion factors for claims being reimbursed at usual and customary values however INFALLIBILL knows that despite the fact that coding and billing for anesthesia services can be complicated there are ways to get higher than average reimbursements simply by doing more efficient work here are some short list line items that you and your team or your billing company just tend to overlook a bit
MODIFIERS ARE KEY
Modifier (A) Anesthesia services performed personally by an anesthesiologist this modifier is used to inform the insurance provider that the anesthesiologist provided care to the patient alone. Modifier (Y) Actual direction of one or more certified and or registered nurses anesthetist from the anesthesiologist on staff. Modifier Q&Y tells the insurance company that the lead anesthesiologist was and is guiding or directing at least one CPN Modifier labeled K Medical guidance of 2,3, or even 4 A type procedures involving CPN’s. Modifier Q and K tells insurance providers that they need to adjust for the anesthesiologist that is directing more than one client case or actual procedure concurrently and or he or she is directing the CRNA on the new case. These are just a couple of examples with many many more. But as important as these may be none of the modifiers are worth anything if they are not reported and followed up by qualifying circumstances.
REPORT, REPORT, REPORT
Qualifying circumstances only should be and can be submitted to the insurance company if the services are reasonable and necessary. Value is significant to the practice and in most cases can and will mean higher payment for the anesthesiologist or nurse practitioner. For example, The patient is admitted for removal of subdural hematoma and undergoes the surgery. The physician mandates that the patient be induced into a, deliberate state of hypothermia to decrease blood flow to the region of the brain. Code 99315 Anesthesia complicated by utilization of controlled hypotension this must be listed separately for the compounded code to deem usual and customary for modifier to be implemented. This is why Infallibill recommends getting the clinicians on the same page so that all notes can be relayed to the Anesthesiology billing company. Example 2 A an older man falls from ledge while walking his dog. He sustains a massive knee injury that is now cutting off blood flow to his ankle. The emergency room physician notes medical necessity for the patient to be admitted immediately to the emergency surgery department to put the knee back into place and restore blood flow to the ankle.
Reverse Append Physical Modifiers
Physical status modifiers can be very profitable for your facility.
Normal folks (units = 0)
Folks with mild systematic issues (units = 0)
More Severe (units = 1)
Disease with Continuous threats to life (units = 2)
Folks who need operation or Life is cut short (units = 3)
Brain dead who potentially is having organs removed (units = 0)
If these are not being reported in clinician notes and sent back to the Insurance providers or “REPORTED” unfortunately this can cost the practice and the practice is missing out on a ton of claim revenue.
Auditing the time with efficiency. A key factor that should be used by your billing provider is the computing of base time units. The use of conversion totals for anesthesia time relevancy. That is: insurance providers know how long it takes for certain procedures for example 00560 Anesthesia for pericardial sac, procedures on heart, without pump oxygenator carries a weight value of 15 base units.Hence for the main providers, the following actual formula is used to report time units for provided anesthesia:
This is just a very basic standard that can give insight on how important it is to have the right equations to this mathematical billing puzzle that not only requires accuracy from your billing company but also the practices clinicians and the software used by those same employees.