Q&A: Rounding time for surgery charges

Wednesday, March 10, 2021

Q: 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: We don't have to follow rounding rules to select the additional 15 minutes after the first 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 one first hour charge and one additional 15-minute charge. The vendor assured us that this was a common practice throughout all hospitals. Is this true?

A: Sort of. Rounding rules that apply based on the CPT® manual or Medicare don't necessarily apply to operating room time because the time drives the charges, not the 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 payers call out when they audit accounts. We avoid the whole thing by charging per minute.

Editor’s note: This question was posted in the Billing and Claims section of the NAHRI Forums.