Getting Paid for Anesthesia Services



Getting Paid for Anesthesia Services


Norman A. Cohen MD



This chapter discusses the anesthesia relative value system as well as the dominant payment system for most other physician services, the Resource-Based Relative Value System (RBRVS). Anesthesiologists need to be familiar with both, as the methods by which insurers calculate payments for our services often involve both systems.


ANESTHESIA PAYMENT SYSTEM

The anesthesia payment system dates back to the early 1960s, when the California Medical Association published an anesthesia relative value guide. This was one of the first examples of a relative value system, in which one valued a physician’s service in comparison to all other physician services. The American Society of Anesthesiologists (ASA) adopted this system in the mid-1960s and has published a relative value guide annually for many years.

This payment system consists of several elements: Base units, time units, and modifier units. Each unit is equal in value.


Base Units.

In the ASA Relative Value Guide (RVG), every anesthetic service has a base unit value assigned. Currently, the base units range from 3 units to 30 units, and the base units reflect the amount of work involved in the pre-anesthetic evaluation, the postanesthetic management, the administration of fluids and blood, intraoperative monitoring, and the overall complexity and intensity of the anesthetic service. Table 209.1 provides examples of base unit values for various anesthetics.


Time Units.

The creators of the anesthesia relative value system understood that the time involved in providing anesthesia care was not in the control of the anesthesiologist. They also understood that time could be highly variable between surgical procedures that were otherwise identical in anesthetic complexity. Therefore, the anesthesia relative value system explicitly identifies time as part of the payment formula. Each time unit represents a defined period of anesthesia care, most typically 15 minutes. According to the ASA, anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room or equivalent area and ends when the patient is safely placed under postanesthesia care. One can think of this as “hands on to hand-off.”









TABLE 209.1 EXAMPLES OF BASE UNIT VALUES FOR VARIOUS ANESTHETICS













































CODE


DESCRIPTOR


BASE UNIT



Surgical Procedure Example


01810


Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand


3



Carpal Tunnel Release


00790


Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified


7



Laparoscopic Cholecystectomy


01173


Anesthesia for open repair of fracture disruption of pelvis or column fracture involving acetabulum


11



Open Repair of Acetabular Fracture


00562


Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator


20



Aortic Valve Replacement


00796


Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; liver transplant (recipient)


30



Liver Transplant

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Jul 1, 2016 | Posted by in ANESTHESIA | Comments Off on Getting Paid for Anesthesia Services
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