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Celebrating our 20th year in anesthesia billing and practice management.

The Summit Resource is
a complimentary monthly
newsletter produced
specifically for Anesthesia
and Pain Management
providers. Our objective here is new and important tor countered that the “anesthe- what is actually happening “in
is to provide you with up news regarding how to proper- sia end” time was not indepen- the field”. Accordingly, we rec-
to the minute billing, ly document your time. Until dently corroborated; therefore, ommend that you revise your
coding, and practice rece ntly, it has been generally it was not acceptable. The audi- time documentation as follows:
accepted in the anesthesia billing tor stated that the CRNA or All pre-op meds should be
management information. community that auditors would anesthesiologist could have char ted on the bar
not quibble about 5 minutes of written down any time he or she graph/timeline of the anes-
The Question: billing prior to entering the OR or wanted as the “anesthesia end” thesia record. If those meds,
Is Modifier-QZ making 5 minutes spent in the PACU. time; therefore it was not suffi- such as Versed, are adminis-
you QueaZy? However, advice to you about ciently corroborative. tered in the pre-op area,
documenting time has changed When asked what would star t char ting the time line
The Answer: due to a new experience. have been acceptable, the audi- in the pre-op area, and write
Coming in March Recently, an anesthesia tor stated that the anesthesia down the Versed administra-
group in Connecticut had under- record itself would have to tion at the appropriate time.
“How to bill when you
gone a Medicaid audit. In that independently document when Example: if Versed is given
fail to meet medical audit, the Medicaid auditor took the CRNA or anesthesiologist in pre-op area at 0700, but
direction documentation the position that the PACU time left PACU. This could be docu- patient is not brought into
guidelines.” was not properly documented. mented on the back of the the OR until 0710; star t
The client had to refund approxi- anesthesia record, in the com- charting time on the anes-
mately $30,000 relating to this ment section of the record, or thesia record timeline/bar

and other issues. on the bar graph/timeline of graph at 0700. At the 0700
What is concerning is that, the record. line, either write down “pre-
despite the fact that the client While we do not agree with op meds” or put an “X” with
had religiously written the anes- this view, we try to provide our a line “X———“ to signify
Healthcare Management Resources thesia start and anesthesia end clients with advice based on the length of time spent with
• Billing, Coding & time on the front of the anesthe-
Accounts Receivable sia record, in a box marketing
Management “anesthesia end,” the auditor dis-
allowed the end time as not
• Compliance Plan being independently documented.
Development and Despite the group’s protests
Implementation in a meeting with the auditor,
• Financial Management the auditor maintained that, One of the biggest threats highlighting your potential
• Automated Resource although he could audit the your anesthesia practice compliance violations and rec-
Scheduling start time against the intra- faces today is Regulator y ommendations for optimizing
operative nurse’s “OR in” time, Compliance. Summit has your business practices.
• Practice Management
there was no recordation by the joined with healthcare
Systems (hardware and
PACU nurse as to when the attorneys who specialize in If you have not addressed
CRNA or anesthesiologist turned Anesthesia to provide a prac- compliance issues to date,
the patient over to the recover y tice review tool we please make this your
room nurse and left the PACU. call Vital Signs for 1st Year 2000 resolution. The
For more information It was argued that the “anes- Anesthesiologists. Vital Signs consequences of not acting
about our services, thesia end” time on the front of is an onsite review which promptly are too great to
contact us at the anesthesia record was for results in a written report ignore.
1-888-854-3822, Ext. 219 that very purpose, but the audi-

Healthcare Management Resources FORT WORTH, TX
2630 West Freeway, Suite 126 PERMIT NO. 2069
Fort Worth, Texas 76102

the patient in the pre-op anesthesia plan are already

area. Alternatively, you can bundled into the base units. Remember: The definition of time
use the footnote (i.e. put a All time, no matter how it is The exception to this rule as defined in the Medicare
small “1” at 0700 with a spent, should be charted on applies if you go over the Carrier’s Manual is: “Anesthesia
corresponding “1” in the the time line/bar graph. An pre-op with the patient at time involves the continuous
auditor should be able to look actual presence of the anesthesi-
comments section where the same time you are
at “anesthesia start” time in ologist (or of the medically-direct-
you write “Versed given administering Versed or
the box on your anesthesia ed CRNA, AA, resident or student
0700-0710 in pre-op.” You another form of anesthesia.
record and see a correlating nurse anesthetist) and starts
may also have some better You can count this time when the physician or anesthetist
way to document this, just and corroborative tick mark because you are also begin- begins to prepare the patient for
ensure that the pre-op on the time line/bar graph. ning to prepare the patient anesthesia care in the operating
meds are somehow docu- Similarly, an auditor should be for the administration of room or equivalent area and ends
mented on the able to look at your stated anesthesia. Simply stated: when the anesthesiologist is no
timeline/bar graph. “anesthesia end” time written You cannot bill for pre-op longer in personal attendance,
in the box on your anesthesia talk unless you are concur- that is, when the patient may be
Similarly when PACU time
record and see a correlating rently administering pre-op safely placed under post-operative
is involved, char t the PACU
and corroborative time char t- meds which means you are supervision.”
in and PACU out time on
ed on the time line/bar graph. actually billing for the
the timeline/bar graph. For
If the start and stop times are pre-op med time, not the Source: Medicare Carrier’s Manual,
example, if the case is
charted on the time line as “talk” time. Section 15018 G
over at 0800, and you
well as written in the boxes
entered PACU at 0810, the
on the anesthesia record ,
timeline/bar graph should
auditors will have difficulty in
note an “X” or tick mark at
disallowing your time.
0805 and a separate “X”
or tick mark at 0810, with
the first “X” or tick mark
noted as “PACU in,” and
the second noted as
“PACU out.” This process Do keep in mind that time If you are stumped by a billing, coding
does not begin when you or practice management question or
may be duplicative, but
talk to the patient in the just need a “second” opinion, contact
based on what the our 48-Hour Anesthesia and Pain
Connecticut Medicaid audi- pre-op areas about the pre-
Management Hotline. We will
tor used as the standard, op exam conducted the day access our network of industry
we would be remiss if we before and/or verifying the experts and guarantee to have a
did not advise you to pro- exam findings. The general response to your question within
tect against such overzeal- rule is that the pre-op exam 48-hours.
ous auditors. and eval, together with the
Just contact Sandi Ross, Director of Practice
This article has been published with the permission of Vaughn & Joaquin Attorneys Development @ 1-888-854-3822, Ext. 219;
Fax: (817) 334-0235 or email:
At Law, 8810 Bluebonnet Blvd, Suite B, Baton Rouge, LA 225-769-1313

Summit Healthcare Management Resources, Inc.

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This newsletter is not intended to render professional services.The publisher assumes no liability for the reader’s use of the information herein.