Anesthesiology Billing and Coding Management
Billing and coding for anesthesia services are unlike most specialties as it is much more challenging and complex, requiring expertise and appropriate tools. At Bristol Healthcare, our seasoned anesthesiology billers and coders, understand the complexities and importance of accurate billing and coding for a successful revenue cycle. Through continuous education programs, our staff stay updated with the ever-changing codes, regulations, and guidelines to ensure that your billing practices remain compliant and your claims are submitted promptly and accurately.
Our coders and billers are well acquainted with:
- Medical Terminology: Thorough understanding of medical terminology, including medical abbreviations and acronyms.
- Anatomy and Physiology: Familiarity with anatomy and physiology to code procedures accurately.
- Techniques and Procedures: Coding for various types of anesthesia, including general, regional, and local anesthesia, and other procedures such as epidurals and nerve blocks.
- Billing and Coding Guidelines: An in-depth understanding of the guidelines specific to anesthesia services.
- Code Modifiers: Expertise in the usage of CPT®, ICD-10, and ASA codes and modifiers, with 99% coding accuracy for clean claims.
- Qualifying Circumstances & Physical Status Modifiers: Employing additional codes for higher reimbursements for the anesthesiologists or CRNA.
- Anesthesia Sheet: Calculating base units, time units, and bundled services for appropriate reimbursements.
- Insurance and Reimbursement: Submitting clean claims, with a claim first pass rate of 96%.
- Electronic Health Records and Medical Billing Software: Extensive expertise in more than 35+ billing and EHR software.
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Certified Resources
Our specialists are AAPC & AHIMA certified.
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HIPAA Compliant
All patient-related data is handled only by authorized personnel.
Purpose-Built Billing Services for Anesthesiologists
Optimize revenue flow effortlessly with our purpose-built anesthesia billing and coding services, designed to boost efficiency throughout the revenue cycle. Our seasoned team ensures accurate coding and meticulous documentation, leveraging the latest technology to handle charge capture, claim submission, and payment reconciliation with precision and efficiency.
Services we provide:
- Patient Pre-authorization and Verification
- Coding and Documentation
- Coding Audit
- Charge Capture and Entry
- Claim Submission
- Payment Posting and Reconciliation
- Denial Management and Appeals
- Accounts Receivable Management
- Old AR Recovery
- Patient Billing and Collections
- Compliance and Regulatory Updates
- Reporting and Analytics
- Education and Training
- Technology Integration
We proactively manage denials and appeals, diligently follow up on accounts receivable, and offer comprehensive patient billing and collections support. With our commitment to compliance and continuous education on regulatory updates, we help your practice navigate the complexities of medical billing, allowing you to focus on delivering exceptional patient care.
Schedule a Free Consultation
With our anesthesiology billing and coding services, you can focus on providing high-quality care to your patients, while we take care of your billing and coding needs. Contact us today to learn more about how we can help you streamline your revenue cycle and maximize your reimbursements.
Schedule ConsultationWhy Leading Healthcare Organizations Partner with Us
- Certified Resources: AAPC™ (CANPC™) and AHIMA™ certified resources, with ICD-9/10, CPT® and HCPCS coding proficiency. Ensuring 99% coding accuracy.
- Specialty-Specific Expertise: Seasoned professionals, with extensive knowledge and experience working alongside Anesthesiologists, CRNAs, and AAs.
- Process Rigor: From pre-operative to post-operative stages, our purpose-built billing and revenue workflows ensure maximized reimbursements - up to 20% in improved revenue.
- Denial Management Mastery: We are adept in navigating payor denial issues such as inappropriate bundling, medical necessity, prior authorization, supporting documentation, time rounding & other underpayment scenarios.
- Cost Savings: Our scalable solutions have helped anesthesiologists save up to 40% on out-of-pocket, staffing, training, administrative, and other back office-related expenses.
- Strict Compliance: Our highly skilled billers, coders, and AR specialists ensure complete adherence to federal, state, and other industry regulations. We’re also 100% HIPAA and HITECH compliant.
- Enhanced Reporting and Analytics: Our medical billing reports provide detailed visibility into the Key Performance Indicators (KPIs) that help you assess and reassess your standard operating procedures effectively. We provide client-specific personalized reports that address their unique challenges and requirements.
- Personalized Support: Upon sign-up, each client is assigned a dedicated account manager and team ensuring undivided attention and personalized support.
Enhancing Billing Efficiency for a Leading Anesthesia Group Practice
This study offers valuable insights into how specialized revenue cycle management can enhance operational efficiency and financial performance for anesthesia practices.
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Our Anesthesia Billing and Coding Workflow
- Determine appropriate anesthesia codes: We determine the appropriate anesthesia codes based on the type of service provided, the duration of the service, and any complications or adverse reactions. The codes used will depend on the type of anesthesia used, such as general anesthesia, regional anesthesia, or monitored anesthesia care.
- Assign appropriate diagnosis codes: In addition to the anesthesia codes, we also assign appropriate diagnosis codes based on the patient's condition or reason for the procedure. The diagnosis codes are used to justify the medical necessity.
- Calculate the anesthesia time: Anesthesia time is calculated from the start of anesthesia to the end of anesthesia, including the time for any pre-operative or post-operative care. The anesthesia time is used to determine the appropriate base units for the service provided.
- Determine appropriate billing modifiers: Depending on the circumstances of the procedure, we use specific billing modifiers to indicate any special circumstances, such as emergency services or unusual anesthesia services.
- Claim submission: Once the appropriate codes and modifiers are assigned, the claim is submitted to the insurance company for reimbursement. The claim includes all the necessary information, such as the patient's information, the services provided, the codes used, and any supporting documentation.
- Claim follow-up: We continuously follow up on the claims to ensure that it's processed correctly and that the reimbursements are received in a timely manner. If the claim is denied, we investigate the reason for the denial and take appropriate action to resolve the issue.
These are some of the key steps involved in our billing process. we ensure our clients get accurate and timely reimbursement for the services provided.
Formula for Calculating the Cost of a Procedure
The cost of an anesthesia service is calculated based on the difficulty of the procedure, duration of the procedure, and other modifying factors such as the health of the patient.
The general formula is: Anesthesia Charge = (Base Units + Time Units + Modifying Units) x Conversion Factor
- Base Unit: Every anesthesia procedure has been assigned a code that has a base unit value. The base unit value indicates the difficulty and skill required for the procedure.
- Time Unit: Each procedure takes a certain amount of time. A time unit is generally 15 minutes in length but maybe 10-12 minutes, depending on the location.
- Modifying Unit: A modifying unit takes into account special conditions such as the patient's health/emergencies that affect the anesthesia plan and administration.
- Conversion Factor: This is the cost assigned to each unit and is specific to the location of the anesthesia provider administering the anesthetic care. This cost will vary across the United States.
Commonly Used CPT and ICD Codes
The medical codes used in anesthesia coding are dependent on the specific procedure being performed, the anesthesia technique used, and the patient's medical condition. Below are some examples of the most commonly used codes in anesthesia:
- 00100: Anesthesia for procedures on the upper anterior abdominal wall.
- 00220: Anesthesia for procedures on the lower back and pelvis.
- 00300: Anesthesia for procedures on the upper leg and knee.
- 00400: Anesthesia for procedures on the lower leg, ankle, and foot.
- 00520: Anesthesia for procedures on the head and neck.
- 00600: Anesthesia for procedures on the upper arm and elbow.
- 00700: Anesthesia for procedures on the lower arm and wrist.
- 00810: Anesthesia for procedures on the upper abdomen.
- R07.89: Other chest pain
- R10.9: Unspecified abdominal pain.
- R53.81: Other malaise and fatigue.
- R55: Syncope and collapse.
- R64: Cachexia.
- Z98.89: Other specified post-procedural states.
- Z95.5: Presence of other cardiac and vascular implants and grafts.
