Treffer: Using Quantity of Service Data in Medicaid Claims to Estimate Anesthesia Time.
Original Publication: Philadelphia : American Society of Anesthesiologists
Silber JH, Rosenbaum PR, Zhang X, Even-Shoshan O: Estimating anesthesia and surgical procedure times from Medicare anesthesia claims. A nesthesiology 2007; 106:346–55. doi:10.1097/00000542-200702000-00024. (PMID: 10.1097/00000542-200702000-00024)
Markus AR, Andres E, West KD, Garro N, Pellegrini C: Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform. Womens Health Issues 2013; 23:e273–80. doi:10.1016/j.whi.2013.06.006. (PMID: 10.1016/j.whi.2013.06.006)
Kaiser Family Foundation (KFF): Health Insurance Coverage of Children 0-18. State Health Facts. Available at: https://www.kff.org/other/state-indicator/children-0-18/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D . Accessed January 12, 2023.
Medicaid and CHIP Payment and Access Commission (MACPAC): Medicaid 101: Administration. Available at: https://www.macpac.gov/medicaid-101/administration/ . Accessed May 9, 2024.
Medicaid Analytic eXtract (MAX) General Information. Centers for Medicare & Medicaid Services. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/MedicaidDataSourcesGenInfo/MAXGeneralInformation . Accessed November 2, 2020.
Ing C, Ma X, Klausner AJ, Dutton RP, Li G: Prolonged anesthetic exposure in children and factors associated with exposure duration. J Neurosurg Anesthesiol 2019; 31:134–9. doi:10.1097/ana.0000000000000540. (PMID: 10.1097/ana.0000000000000540)
Co. Colorado Medical-Surgical Billing Manual: Colorado Department of Health Care Policy and Financing. Available at: https://hcpf.colorado.gov/med-surg-manual#anesthServ . Accessed August 2, 2023.
Fl. Florida Practitioner Fee Schedule: Florida Agency for Health Care Administration. Available at: https://ahca.myflorida.com/content/download/20095/file/Practitioner_Fee_Schedule_2022_July.pdf . Accessed August 2, 2023.
Medi-Cal: Medi-Cal Anesthesia Manual. Available at: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/A742D5B5-5CA4-4D4E-B4A4-8363A98628EF/anest.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO . Accessed January 5, 2024.
American Society of Anesthesiologists: Anesthesia Payment Basics Series: #3 Payment, Conversion Factors, Modifiers. Available at: https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-3-payment-conversion-factors-modifiers . Accessed Feburary 15, 2024.
American Society of Anesthesiologists: Anesthesia Payment Basics Series: #4 Physical Status. Available at: https://www.asahq.org/quality-and-practice-management/managing-your-practice/timely-topics-in-payment-and-practice-management/anesthesia-payment-basics-series-4-physical-status . Accessed February 20, 2024.
Professional Practice Series, 20th Anniversary Edition. A Guide for Surgery/Anesthesia CPT Codes 2014 Crosswalk. American Society of Anesthesiologists.
Schober P, Boer C, Schwarte LA: Correlation coefficients: Appropriate use and interpretation. Anesth Analg 2018; 126:1763–8. doi:10.1213/ANE.0000000000002864. (PMID: 10.1213/ANE.0000000000002864)
Samples H, Lloyd K, Ryali R, et al.: Completeness and quality of comprehensive managed care data compared with fee-for-service data in national Medicaid claims from 2001 to 2019. Health Serv Res 2025; 60:e14429. doi:10.1111/1475-6773.14429. (PMID: 10.1111/1475-6773.14429)
Silber JH, Rosenbaum PR, Zhang X, Even-Shoshan O: Influence of patient and hospital characteristics on anesthesia time in Medicare patients undergoing general and orthopedic surgery. A nesthesiology 2007; 106:356–64. doi:10.1097/00000542-200702000-00025. (PMID: 10.1097/00000542-200702000-00025)
Silber JH, Rosenbaum PR, Ross RN, et al.: Racial disparities in operative procedure time: The influence of obesity. A nesthesiology 2013; 119:43–51. doi:10.1097/ALN.0b013e31829101de. (PMID: 10.1097/ALN.0b013e31829101de)
Patoir A, Payet C, Peix JL, et al.; CATHY Study Group: Determinants of operative time in thyroid surgery: A prospective multicenter study of 3454 thyroidectomies. PLoS One 2017; 12:e0181424. doi:10.1371/journal.pone.0181424. (PMID: 10.1371/journal.pone.0181424)
Weitere Informationen
Background: Surgical procedure duration and anesthesia time are important variables, with applications including measurement of quality of care and quantity of anesthetic exposure. This study evaluates data from Medicaid anesthesia claims as a proxy for anesthesia time.
Methods: Fee-for-service anesthesia claims for appendectomies and cholecystectomies of beneficiaries under age 65 yr from the Medicaid Analytic eXtract (1999 to 2013) were identified. The quantity of service (QoS) variable in anesthesia claims was evaluated on three criteria: (1) reflection of expected anesthesia time, (2) correlation with Medicaid payment, and (3) state interpretation of QoS as anesthesia time by evaluating payments estimated using state-specific billing rules and correlation with actual payments. Spearman correlations were calculated with coefficients above 0.7 considered to be strong.
Results: A total of 902,492 fee-for-service anesthesia claims were identified from 48 states and Washington, D.C., with 14 states reporting QoS values in units, 19 reporting in minutes, and 16 reporting in both units and minutes. The median QoS values for appendectomy and cholecystectomy were 6 and 7 U in claims reporting time in units and 76 and 89 min in claims reporting time in minutes, respectively. The majority of unit states (9 of 14; 64%) and minute states (14 of 19; 74%) met all three criteria. For the 16 states reporting QoS values in both units and minutes, 8 of 16 (50%) reported unit claims and 9 of 16 (56%) reported minute claims that met the three criteria.
Conclusions: The QoS variable reported on state Medicaid anesthesia claims had utility in approximating anesthesia time as minutes or 15-min units when evaluating anesthesia claims from two common surgical procedures. However, this variable does not accurately reflect anesthesia time in every state, and even in states where QoS was deemed to be usable, outliers and misclassified data need to be addressed.
(Copyright © 2025 American Society of Anesthesiologists. All Rights Reserved.)