Anesthesiologists can collect their reimbursements the right way using the following reimbursement formulas for time-based anesthesia services:
Reimbursement Formula For Anesthesiology Without Modifiers AD*= ([Base Unit Value + Time Units + Modifying Units] xConversion Factor) x Modifier Percentage.
Reimbursement Formula For Anesthesiology Without Modifiers AD*= ([Base Unit Value of 3 + 1 Additional Unit if anesthesia notes indicate the physician was present during induction] x Conversion Factor) x Modifier Percentage.
Breakdown of the Standard Anesthesia Formula:
Base Values:
The American Society of Anesthesiologists (ASA) assigns a Base Value to each CPT anesthesia code (00100-01999). The UnitedHealthcare uses these values to determine reimbursements for anesthesia services. Base value of each code has a unique unit that is referred to as its Base Unit Value.
Time Reporting
UnitedHealthcare requires time-based reporting of anesthesia services with the addition of one-minute to the actual Anesthesia Time. For example, if the actual Anesthesia time is 1 hour then 60 minutes should be submitted. The ASA indicates that it is essential to place post-surgical pain blocks frequently before anesthesia induction or after anesthesia emergence. If the block is placed before induction or after emergency, then you can’t add time taken to place the block to the reported anesthesia time. It will be applicable even if sedation and monitoring is provided to the patient during block placement.