In a blog post, Anesthesia Business Consultants CEO and President Tony Mira examined the changing anesthesia documentation and billing landscape.
Here's what you should know.
1. The simple days of straightforward billing are gone as more claims are routinely denied. Mr. Mira said the largest cause of anesthesia claims denial stems from improper documentation of medical necessity.
2. A patient may need monitored anesthesia care or other services, but it must be well documented in the anesthesia record, including the one sent to a billing and coding partner or coding department.
3. Anesthesia providers must follow a growing number of requirements to show medical necessity. These include national and local coverage determinations as well as the specific and evolving policies of third-party payers.
4. Mr. Mira said medical necessity for anesthesia isn't required in large and obvious cases, where anesthesia need is claer, but is instead relevant in in relatively simple cases including endoscopy, cataract and podiatry procedures, among others.
5. He said, "The ability to show medical necessity in anesthesia hinges on the ability to document that the patient has one or more comorbidities that necessitate anesthesia services beyond sedation. In surgery, need is justified by the diagnosis. In anesthesia, need is justified by the presence of comorbidities in the patient at that moment in time."
For more information, click here.