Is your patient ASA classification costing your practice money?

Each time that an anesthetic is rendered, the patient is assigned an ASA physical status modifier which describes the complexity of the service provided.

Although many practitioners see this as simply a clinical designation, few realize that the misclassification of these modifiers can result in lost revenue for their practice.

The problem stems from the somewhat vague descriptors that represent these modifiers (e.g., mild vs. severe systemic disease) and the corresponding comorbidities that can be used to support them. Historically, anesthesia providers had to use their clinical discretion to determine correct modifier usage on patients, and there was great disparity in application, even within the same anesthesia group.

From a billing perspective, ASA 1-ASA5 designations are converted to modifiers P1-P5 on a claim form. These modifiers are significant for two reasons. First, many managed care plans pay extra for modifiers P3-P5, typically 1-3 additional units per case respectively. Second, these modifiers are often directly tied to coverage thresholds for anesthesia on services such as lower GI endoscopy. When appropriate, modifiers P3 and above can help to substantiate medical necessity for payment by clarifying the patient’s underlying conditions relevant to the case.

Take, for example, a morbidly obese patient with a BMI of 40. Due to the patient’s comorbidity, they represent higher risk to the anesthesia provider, and a designation of ASA 3 is appropriate to signify such risk. However, many anesthesia providers are unaware of this criteria, and may erroneously mislabel the patient as an ASA 2, potentially resulting in a partial or total loss on the claim.

To assist anesthesia providers in this endeavor, both the ASA and the Cleveland Clinic have published guidelines that provide clinical examples for each physical status modifier. We recommend all anesthesia practices review these guidelines with their group members to ensure consistency in documentation and to prevent lost revenue. Attached below are the links to assist you in obtaining this information.

https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system

https://my.clevelandclinic.org/health/articles/asa-physical-classification-system

About the author
Hal Nelson is VP Compliance for Medac Anesthesia Business Partners. Awarded the designation of Certified Professional Coder in 1998, Hal has previously taught coding certification classes collegiately in Atlanta, GA. He has 25 years of experience on both the payer and billing side of the business, and is one of the compliance executives in charge of supporting auditing and compliance initiatives. He has extensive knowledge of compliance issues related to anesthesia and pain management billing.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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