Rounding for Surgery Level Time Charges
Our system has a new vendor that is helping with charge capture. We were discussing surgery level charges and a comment was made about rounding that surprised me a bit. We don't have to follow rounding rules to select the additional 15M after the 1st hour. The vendor acknowledged that Medicare does have rounding rules but because the rounding rules are not listed in or specifically tied to any surgery documentation, then the rounding rules don't apply to surgery. If the total surgery time was 61 minutes, then we would have 1 first hour charge and 1 add'l 15M charge. The vendor assured us that this was a common practice throughout all hospitals.
Is this true? No one follows rounding rules anymore?
Thanks!
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Sort of. Rounding rules that apply based on the CPT book or Medicare don't necessarily apply to operating room time, as the time drives the charges not CPT/HCPCS units. Each hospital should have a policy that they consistently follow. That said, I would be surprised if this wasn't something that insurances would call out when they audit accounts. We avoid the whole thing by charging per minute.
Thanks! How do you cover the higher costs that are normally associated with the first hour? Do you have any state codes that require additional work behind the scenes? Medi-Cal, our state's Medicaid program, requires three separate codes for surgeries--first hour, first subsequent half hour and second subsequent half hour.
Agree with Andrew's reply in regards to the rounding explanation. There is no timed CPT assigned to the OR Class charge, so CPT rounding rules would not apply. We have a policy that defines how we charge OR time. It specifies the start/stop time of the procedure and how we charge in units. Our practice matches what your vendor recommends.
Would you all agree that the same is true for recovery time? It is charged in a similar manner to surgery time, and has no specific CPT codes that are tied to any rounding rules. It seems that PACU time would be the same. What are your thoughts?
Thanks,
Marie
Our recovery charges are reported in 710 without a CPT on the claim. We have them defined to charge in time increments and the Epic/OpTime/Cupid/Radiant system will trigger the charges for phase 1. Phase 2 and extended recovery [after 6 hours] is calculated and charged by our RCA/Revenue capture analyst staff. Once the time increment is one minute into the next unit, the next unit charges. so yes, similar to our OR charges.