By CMS’s definition, "Anesthesia time is defined as the period during which an anesthesia practitioner is present with the patient. It starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area and ends when the anesthesia practitioner is no longer furnishing anesthesia services to the patient, that is, when the patient may be placed safely under postoperative care. Anesthesia time is a continuous time period from the start of anesthesia to the end of an anesthesia service. In counting anesthesia time for services furnished on or after January 1, 2000, the anesthesia practitioner can add blocks of time around an interruption in anesthesia time as long as the anesthesia practitioner is furnishing continuous anesthesia care within the time periods around the interruption."1 This definition is the widely accepted standard, though some payers may not follow this definition.
Anesthesia start time is not dependent upon the patient being in the operating suite and may begin in the holding area. It is typically started when the anesthesia provider places IVs, monitors, administers sedation or performs other like services associated directly with the anesthesia service. Anesthesia end time occurs when the provider transfers the care of the patient to another healthcare provider, typically in the post-anesthesia care unit (PACU).
While there is no industry standard on just how much time can be spent with the patient and billed prior to induction or after the end of surgery, keep in mind that medical necessity plays a part in what is deemed a covered service by payers. It’s also important to understand that an interruption of the period of personal attendance by an anesthesia provider should be deducted from any reported time when it occurs. However, any time the provider feels is medically necessary should be reported. Documentation on the anesthesia record should support any inordinate time spent with the patient prior to induction or after the end of the surgery.
Reported anesthesia time does not include time spent performing the pre-anesthesia evaluation or the post-anesthesia evaluation. Time spent performing these anesthesia components are accounted for in the procedure’s base units.
Post-operative pain management services, when not used as part of the anesthetic procedure, are separately billable. No time is reported in conjunction with the CPTs for billing purposes. Payment for these services is made based on the Relative Value Units (RVUs) of the procedure. The professional work component of payment includes the time associated in performing the procedure.
Similarly, other ancillary services such as arterial lines are paid a flat-fee rate based on the work value of the procedure. Time spent performing these services is included in the payment rate.
As most separately identifiable procedures are performed prior to induction, time spent performing the post-operative pain service or ancillary services should be documented separately from the anesthesia time and should not be included in the reported anesthesia time. The exception to this occurs when these services are performed after induction. ASA position statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia says, "In the less common circumstance where a block is placed during a general anesthetic, time does not need to be deducted as the full anesthesia service is still being performed."2