CMS defines surgical anesthesia time as the continuous, actual presence of the anesthesiologist or CRNA. Surgical anesthesia time begins when the physician or CRNA starts preparing the patient for the anesthesia procedure — in the operating room or equivalent area — and ends when the anesthesia practitioner is no longer in personal attendance. The CPT® definition is similar:

Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.

In either case, time is counted from the moment the practitioner starts an intravenous line, places monitors, administers pre-anesthesia sedation, or otherwise physically begins to prepare the patient for anesthesia. Time stops when the practitioner releases the patient to the care of the post-anesthesia recovery unit (PACU) personnel.

Time spent reviewing the patient’s medical record prior to surgery is not billable anesthesia time, but is considered to be part of the pre-operative evaluation.

Note that CMS and most insurers recognize that there may be breaks or interruptions in anesthesia care. When this occurs, the practitioner may count the time before and after the interruption, as long as the practitioner is furnishing continuous anesthesia care within that time. Most practice management and documentation software applications allow for the entry of multiple anesthesia start and stop times to accommodate discontinuous time.