Anesthesia

The Anesthesia reimbursement tool allows you to calculate expected reimbursements for anesthesia charges. You can calculate expected reimbursements for charges that are billed as units and for charges that are billed as minutes. For the purpose of this tool, anesthesia charges are procedure codes that begin with a zero and end with a number or charges that have a type of service of seven.

Some anesthesia codes should process as a percentage through the Line Item Percentage reimbursement tool. To select specific codes to ignore when repricing with the Anesthesia reimbursement tool, select the Select codes in check box and indicate the lookup table of your choice.

• These codes are repriced with the Line Item Percentage reimbursement tool. For more information, refer to Line Item Percentage.
• The Select codes in check box defaults to not unselected.

The first table in the Anesthesia reimbursement tool allows you to define how minutes are converted into time-based units.

• You must select the Convert minutes to unit check box to enable the fields in this table.
• The Converting Minutes From/To fields let you define different conversions for different ranges of minutes. For example, you can convert the first 150 minutes differently from the second 150 minutes.
  • Leave both fields blank to use the same conversion for all minutes.
  • You can leave either the From or To field blank. For example, if you leave the From field blank and enter 150 in the To field, you define a range of 0 to 150. If you enter 151 in the From field and leave the To field blank, you define a range of all minutes greater than 150.
  • You cannot overlap ranges in these fields. For example, enter a range of 0 to 150 and 151 to 300 instead of 0 to 150 and 150 to 300.
• The Minutes per Unit field defines the number of minutes that equal one unit.
• The Rounding Logic field defines how to round remainders when converting from minutes to units.
• The Apply To field lets you select a procedure lookup table. If you select a procedure lookup table, the conversion logic only applies to codes found in the selected table. If you do not select a procedure lookup table, the conversion logic applies to all anesthesia procedure codes that have not been priced by another reimbursement tool.

The second table in the Anesthesia reimbursement tool allows you to define the conversion factor used to calculate the reimbursement per billable unit. The amount you enter in the Conversion Factor field is multiplied times the sum of all units for each procedure in the selected procedure lookup table.

• The Reimbursing Through field lets you select a procedure lookup table. The base anesthesia units found in the procedure lookup table will be used in the calculation.
• The Modifier Table field lets you select the lookup table used to define the modifier units or modifier percentages for the selected procedure lookup table.
• The Qualifying Circumstance field lets you select the lookup table to use to define any qualifying circumstances for the selected procedure lookup table.

A procedure code matches an entry in a lookup table according to standard matching rules. For more information, refer to Reimbursement Tools.