SpecialtiesSurgical
How we see anesthesia billing.
Reviewed by the VisMed surgical billing team
An anesthesia claim is built from base units for the procedure, time units from documented start and stop, and modifiers that describe the patient’s physical status, qualifying circumstances and, most importantly, the care model: personally performed, medically directed at a ratio, medically supervised, or CRNA alone. Payers multiply the units by their own conversion factor and pay the physician and CRNA shares according to the modifier. Any error in the time, the modifier or the concurrency changes the payment on every case that day.
Concurrency is the discipline most groups get wrong. Medical direction has conditions and a ratio limit; exceeding the ratio or failing a condition changes the modifier and the payment for every room involved. Documentation of the required elements has to be there for every case.
VisMed runs a concurrency check on every case day before claims are built, our coders take base units and modifiers from the record, and we hold each payer’s conversion factor, rounding and CRNA rules per plan and check payments against them.
Where anesthesia practices lose money
The patterns we find in the aging and denial history before anything else changes.
Time documentation
Start and stop times that are missing, rounded or inconsistent with the operating room record lose minutes and invite audits.Concurrency and medical direction
Ratios exceeded or direction elements undocumented change the care-model modifier and the payment across every concurrent case.Physical status and qualifying circumstances
Modifiers for physical status, emergency, extreme age and hypothermia add units on payers that recognize them, and are often omitted.Base unit errors
The base code follows the surgical procedure actually performed; changes in the operating room that are not reflected in the anesthesia record bill the wrong base.Payer-specific rules
Conversion factors, unit rounding, modifier recognition and CRNA payment policies differ by payer. Applying one set to all is a systematic error.
What we do differently for anesthesia
Specialty-matched coders and a denials specialist, working inside your own system.
We check concurrency daily
Every case day is reviewed for concurrency and direction elements before we build claims, so the modifier reflects what happened.We code from the record
Base units from the procedure performed, time from the anesthesia record reconciled to the operating room log, modifiers from the documentation.We hold payer rules per plan
Conversion factors, rounding, recognized modifiers and CRNA policies held per payer and applied at claim build; payments checked against them.We cover every care model
Personally performed, medically directed, supervised and CRNA-alone claims built correctly for each case and each provider.
What we bill
The procedure and code families your account team already works in.
Anesthesia billing, asked and answered.
What a physician-owner in this specialty asks on the first call.
How does VisMed handle medical direction and concurrency?
With a daily review of every case day. VisMed calculates concurrency from the times across all rooms, checks the direction elements in the documentation, and sets the care-model modifier from that, not from a default. Where a ratio is exceeded, the claims are built under the correct model.
Why do payments vary so much between payers?
Because each payer sets its own conversion factor, unit-rounding method, recognized modifiers and CRNA policy. VisMed holds those per plan, builds claims to them and compares payments with them, so underpayments are caught.
How does VisMed bill labor epidurals?
Under each payer’s method: time-based with caps, flat rates or base-plus-time, with the start and stop documentation the payer requires. VisMed holds the rule per plan.
Can VisMed bill post-operative pain blocks separately?
When performed for post-operative pain at the surgeon’s request and documented as separate from the anesthetic, yes, with the applicable modifier. VisMed checks the documentation supports it on every case.
Does VisMed enroll our CRNAs and anesthesiologists with payers?
VisMed’s credentialing team enrolls each anesthesiologist and CRNA with every payer the group bills, tracks revalidations, and keeps the group’s reassignment and supervision arrangements current, because a claim under a provider the payer has not enrolled is denied regardless of how well it was coded.
Also in surgical
General surgery
Global-period tracking and assistant-at-surgery claims.
Orthopedics
Fracture care, implants and DME.
Neurosurgery
Multi-level procedures and co-surgeon billing.
Vascular surgery
Office-based labs and imaging supervision.
Thoracic surgery
Complex globals and critical-care overlap.
Plastic surgery
Reconstructive vs cosmetic separation.
Oral & maxillofacial surgery
Medical and dental claims on one case.
ENT
In-office procedures, audiology and allergy.
Ophthalmology
Eye-code vs E/M choice, injections and ASC.
Urology
Lithotripsy, in-office procedures and pathology.
OB/GYN
Global obstetric packages and gyn procedures.
Ambulatory surgery centers
Facility claims, implants and payer-specific groupers.
All specialties
The full list, in six groups
See where your anesthesia practice is losing money. Free.
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