2 reasons why insurers use physical status modifiers for anesthesia

Anesthesia coders must carefully review medical records to determine appropriate billable elements, such as a patient's ASA physical status classification, according to Anesthesia Business Consultants President and CEO Tony Mira.

The American Society of Anesthesiologists adopted the ASA Physical Status Classification System in the 1970s to indicate anesthesia complexity and justify additional insurance payments.

It's important that all members of anesthesia groups understand the physical status modifiers and how they're applied, according to Mr. Mira.

What you should know:

The ASA Physical Status Classification System includes six categories for classifying a patient's preoperative surgical risk. They are:

1. Healthy person
2. Mild systemic disease
3. Severe systemic disease
4. Severe systemic disease that is a constant threat to life
5. A moribund person not expected to survive without surgery
6. A person declared brain dead whose organs are being removed for donor purposes

Insurers use the physical status modifiers for two reasons:

1. To help support medical necessity. Some insurance plans require physical status modifiers even if there's no separate payment for them.

2. For contractual carve outs. Some managed care contracts pay additional units per case for categories three and above.

More articles on anesthesia:
Managing anesthesia services in ASCs — 5 top problems + solutions
5 questions to ask ASC anesthesia providers
CRH Medical acquires Florida gastroenterology anesthesia practice — 3 insights

© Copyright ASC COMMUNICATIONS 2020. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.


Featured Webinars

Featured Whitepapers