Importance of Correctly Documenting
ASA Physical Status Modifiers

By: Hal Nelson, CANPC
Vice President, Anesthesiology Services
MSN Healthcare Solutions

ASA Physical Status Code

If you were to ask 100 anesthesia providers what a patient’s underlying condition(s) warranted in the form of an ASA Physical Status code, you would most likely get a varied response. This is what the American Society of Anesthesiologists discovered after doing a recent study.

The cause – these risk identifiers are subjective in nature, leading to a lack of consistency in application, often by anesthesia providers within the same group practice.

ASA Physical Status Modifiers

The modifiers are as follows:

  • ASA 1 – Normal healthy patient
  • ASA 2 – Patient with mild systemic disease
  • ASA 3 – Patient with severe systemic disease
  • ASA 4 – Patient with severe systemic disease that is a constant threat to life
  • ASA 5 – Moribund patient who is not expected to survive without the operation
  • ASA 6 – Declared brain-dead patient whose organs are being removed for donor purposes

Commercial and Non-Federal Revenues

Although there may not be a heightened level of concern by practitioners over this labeling system, perhaps there should be. Although Medicare does not pay extra for the physical status codes, they can make a big difference for commercial and other non-federal revenues.

Take, for example, patients with poorly controlled diabetes/hypertension, or those with a BMI score of 40 or higher. These patients qualify as an ASA 3, but are often designated as an ASA 2 in error. 

Also consider patients with a recent history (past 3 months) of Transient Ischemic Attacks (TIA) or Coronary Artery Disease (CAD) with stents, which are sometimes undervalued from their appropriate level of an ASA 4.

Training on how to appropriately use this risk rating system typically comes in the form of anesthesia providers asking their colleagues what modifier they would assign. Of course, this approach only works well when the person that you are consulting with has the correct answer.

From a billing standpoint, many insurance plans pay an additional 1-3 units for ASA 3-5, respectively. Some payors also use “ASA 3 and above” as the threshold for coverage on many Monitored Anesthesia Care (MAC) and GI endoscopy procedures.

The bottom line – If providers within a group practice don’t have a clear understanding of this labeling system, it will cost their employer real money.

ASA Physical Status Indicators

To provide assistance on this front, MSN Healthcare Solutions has included a link below that supplies current definitions and examples for each ASA Status indicator.

It is recommended that practices print a copy of this guide and place in a conspicuous location within their anesthesia office, to promote dialogue and ensure uniformity in charting.

Hal Nelson, Vice President Anesthesiology Services


VP of Anesthesiology Services

Hal has 30+ years of experience on both the payor and RCM side, with a focus in Anesthesia. He formerly worked as a senior claims approver at United Healthcare, as well as a compliance officer for multiple national anesthesia billing companies. His broad-based experience ensures that MSN clients have a resource for documentation and billing issues. His past speaking engagements include ASA, MGMA, Dartmouth, and Johns Hopkins.

This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document.  All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.

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