Anesthesia billing errors can quietly drain an ASC’s revenue, and many facilities don’t realize how much they’ve lost until the damage is done.
From missed case captures to miscoded positioning and inaccurate ASA status assignments, these are the most costly anesthesia billing mistakes ASCs and other outpatient facilities make, according to three anesthesia leaders.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s the most costly anesthesia billing or coding mistake you see ASCs or other outpatient facilities make?
Megan Friedman, DO. Chair and Medical Director at Pacific Coast Anesthesia Consultants (Los Angeles): Missed or incomplete capture of anesthesia cases, often driven by lack of tight oversight of the anesthesia billing vendor. Because revenue is unit-based, small documentation or reconciliation gaps compound quickly, and when vendors miss cases or fail to align with procedural logs, it results in significant, and often unrecognized, revenue leakage.
Jordan Newmark, MD. Adjunct Clinical Associate Professor of Anesthesiology at Stanford University School of Medicine (Palo Alto, Calif.):
- Not documenting billing for the exact surgical procedure that was performed, as the anesthesia record and surgery op note must match exactly
- Not documenting billing for anesthesia positioning properly, especially “field avoidance” positioning for airway
- Not documenting billing for one lung ventilation
- Not documenting billing for emergency airway procedures (for example, reintubation in PACU)
- Not characterizing the ASA status of the patient accurately, especially when the patient is an ASA3 but documented in the anesthesia record as an ASA2
Bronson Taylor, CRNA. Executive Vice President of Clinical Affairs at CCI Anesthesia (Pensacola, Fla.): The costliest issue today isn’t a traditional coding error; it’s a misalignment between operational efficiency and the anesthesia delivery model. Many ASCs still operate with a “convenience-first” mindset, where scheduling gaps, low-acuity case mixes, and inconsistent block utilization create inefficiencies that billing alone can’t overcome. Even with strong coding and revenue cycle performance, anesthesia reimbursement is no longer sufficient to offset rising labor costs in inefficient environments. The result is a structural financial gap, not a billing gap.