The question of whether there is anomalous billing in anesthesia care is beginning to be asked by operating room managers, health care administrators, policy makers, and regulators. This question may arise when an anesthesia case seems to take more time to complete than it should. Audits, when conducted, have found that an unusual number of claims end with the digits 0 or 5 as if large numbers of cases start or end on the 5-minute mark. Such a finding serves as a red flag for that practice to undergo an audit. Questions may also be raised because the percentage of patients coded as having a higher anesthesia risk, using the American Society of Anesthesiologists Physical Status Classification System, has increased from 2.9% in 2005 to 13.2% in 2013, mainly because coding a patient’s physical status at a higher classification or anesthesia risk in a claim ensures better payment of the claim.
Coustasse A, Frame M, Mukherjee A. Is Upcoding Anesthesia Time the Tip of the Iceberg in Insurance Fraud? JAMA Netw Open. 2018;1(7):e184302. doi:10.1001/jamanetworkopen.2018.4302