BMI, Calculating It will Provide Clinical Support to Anesthesia

Anesthesia groups should educate providers and focus on the pre-evaluation documentation to help support the specific risk factors or medical conditions that validate the need for an anesthesia provider.  A perfect example is the documentation for morbid obesity.  We see this written on the records but many of the policies we are seeing state that the BMI must be greater than 40.  Rarely do we see documentation that gives the patient’s exact BMI so that the record would clearly support the policy if audited.  Having a focused audit on the pre-evaluations for MAC services would be a very good step for anesthesia compliance programs.


This issue is not new and it is not going away.  As we have predicted, more and more carriers are limiting payment for these services.  Anesthesia billing professionals and managers should monitor the draft policies and immediately go into action by working with their state societies when the draft policies are issued. 


In addition, anesthesia groups should develop financial policies that can be presented to the patient up front that explains medical necessity limitations from the carrier and gives the patient an option to pay for the services personally.  While this does put anesthesia groups in unfamiliar territory of collecting payments at time of service, getting paid for the services will be necessary, if a group is to survive.