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Have your documentation prepared for reporting level P4 and higher. Physical status modifiers, also known as P modifiers, PS modifiers, ASAs or ASA P codes, are a significant element of your anesthesia medical billing and coding. In case you don’t use them appropriately, you could miss your reimbursement opportunities, or risk a payer audit. Avoid P Modifiers With Medicare, Nonetheless Check Private Payers In case your anesthesiologist works with a number of Medicare patients, you possibly haven’t devoted much time learning the detailed points of anesthesia’s Physical Status Modifiers. Why? Owing to the reason that Medicare does not pay for them. End of story, is this what you think? Not in case your practice contracts with private payers. A lot of private payers will frequently reimburse for P modifiers in case you follow the medical billing and coding guidelines. Reporting is reliant on the carrier and can be reliant on on whether the group negotiated for it in their contract. Maximum government payers do not permit reporting or payment of PS modifiers. Use 6 Levels to Outline Patient’s Status The American Society of Anesthesiologists (ASA) developed physical status modifiers to let coders differentiate between different levels of complexity of anesthesia service. These levels are based on the patient’s condition, as mentioned follows: - P1 – (Normal healthy patient)
- P2 -- (Patient with mild systemic disease)
- P3 -- (Patient with moderate systemic disease which can be a threat to life)
- P4 -- (Patient with severe systemic disease that is a constant threat to life)
- P5 -- (Moribund patient who is not expected to survive with or without the operation)
- P6 -- (Declared brain-dead patient whose organs are being removed for donor purposes)
The ASA does not offer solid definitions for physical status modifiers as their use is entirely based on clinical decisions the anesthesia provider carries out for each patient. Medical Billing and Coding Tip: Most of your anesthesiologist’s services need a P1, P2, or P3 modifier. To use P4 or higher, you require strong documentation in the medical record to support its use. Even though your anesthesiologist classifies a patient as P3, many payers will want further information to support the claim. Make Certain You Clarify Dx and Documentation In its “Revised Hospital Anesthesia Services Interpretive Guidelines," CMS proposes explanation on minimum accepted standards of what must be included in a pre-anesthesia assessment of a patient, including “notation of anesthesia risk as per established standards of practice (e.g. ASA classification of risk)." Why it’s important: The preop note must frequently include PS classification. In case it doesn’t, your practice may not be meeting the terms of CMS rules. The best way to ensure you’re using the proper PS code is to check, and double-check, your physician’s documentation. In many cases you can find the ASA classification which is included in the operating room nurse’s notes. Note: For accurate medical billing and coding, You cannot use a PS code with an add-on code for instance +01953 (Anesthesia for second- and third-degree burn excision or debridement with or without skin grafting, any site, for total body surface area [TBSA] treated duringanesthesia and surgery; each additional 9% total body surface area or part thereof).
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