Anesthesia

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ANESTHESIA
By: Naser C. Masilam, RN

INTRODUCTION


Anesthesia codes are grouped
beginning with the head.

anatomically,



Many anesthesia codes indicate “not other wise
specified” for example, code 00920 describes
anesthesia for procedures on male genitalia
(including open urethral procedures) ; not other
wise specified.



Coders either look for anesthesia in the CPP Index
– to locate correct anatomical area, or turn to
Anesthesia 00100 – 00210 Section in CPP and look
under appropriate anatomic heading.

INTRODUCTION


Keep in mind, codes are not always found under
the surgical description and the coder may need
to default backward to find the most accurate
description.



For example, code ranges for anesthesia for a
simple MASTECTOMY are not listed under
mastectomy, but rather under BREAST.



Although, the liver is located in the upper
abdomen, the harvesting of a liver is reported
with code 01990 Physiological support for
harvesting of organ(s) from a brain – dead patient,
which is listed under “Other Procedures”.

TYPES OF
ANESTHESIA
GENERAL ANESTHESIA

“It is a drug
induced that can
loss consciousness.”

TYPES OF
ANESTHESIA
REGIONAL ANESTHESIA
It losses sensation in a
specific region of the
body, using techniques
such as:
• Spinal Anesthesia
• Epidural Anesthesia
• Nerve block/ Local
nerve block

TYPES OF
ANESTHESIA
MONITORED
ANESTHESIA CARE


The patient is under light sedation or
no sedation while undergoing surgery
with local anesthesia provided by the
surgeon.



The service is monitored by an
anesthesia provider who is at all times
prepared to convert MAC to General
Anesthesia if necessary.


Local Anesthesia is not reported
using
anesthesia
codes.
It
included in the Surgical Package
and not recorded separately.

ANESTHESIA PROVIDERS
ANESTHESIOLOGIST
He is a physician to
practice medicine and
who is completed an
accredited anesthesiology
program.
• Personally performed
• Medically direct
• Medically
supervised
members
of
an
anesthesia care team

ANESTHESIA
PROVIDERS
CERTIFIED REGISTERED
NURSE ANESTHETIST

(CRNA)
Completed an accredited
anesthesia
nurse
program:


Maybe either directed
by an anesthesiologist
or
non
medically
directed

ANESTHESIA PROVIDERS
ANESTHESIOLOGIST
ASSISTANT
(AA)

He is healthcare
professional
completed an
accredited anesthesia
assistant training
program. May only be
medically directed by
an anesthesiologist.

ANESTHESIA
PROVIDERS
ANESTHESIA RESIDENT
Completed medical
degree currently in a
residency program
specifically for
anesthesiology training .

ANESTHESIA
PROVIDERS
STUDENT REGISTERED
NURSE ANESTHETIST

(SRNA)
Training in an
accredited nurse
anesthesia program

ANESTHESIA CODING
TERMINOLOGY
 One

– Lung Ventillation

 Pump

Oxygenator

 Intra-

Peritoneal

 Extra

– Peritoneal (Retroperitonel)

 Radical
 Diagnostic/

Surgical Arthroscopic Procedure

CPT CODING


Includes:
 All

usual pre operative and post operative visits

 Anesthesia

care during the procedure

 Administration

of fluids and/or blood products

during surgery
 Non-

invasive monitoring (ECG, Temperature, Blood
Pressure, Pulse Oxymetry, Capnography and Mass
Spectrometry)



Unusual forms
arterial lines,
artery catheter
in the base unit

of monitoring – for example,
central venous and pulmonary
(Swan – Ganz) – are not included
value of anesthesia codes.

CPT CODING


Anesthesia Time begins when the anesthesiologist
begins to prepare the patient for anesthesia in
either in operating room or an equivalent area.



Pre – Anesthesia Assessment Time is not part of
reportable anesthesia time.



Anesthesia time ends when the anesthesiologist is
no longer in personal attendance, and generally is
reported when the patient is safely placed under
post operative supervision.



The surgical time does not play a role in
determining anesthesia time.

CPT CODING
 Only

one anesthesia code is reported during
anesthesia administration, except in a case
where there is an anesthesia add on code.

 For

example, the anesthesia section of CPT
has add on codes listed under Burn Excision
or Debridement and Obstetric.

 These

add on procedures may not be
reported alone; they must be reported with
the applicable primary anesthesia code
referenced in parenthesis.

PHYSICAL STATUS MODIFIER


P1 a normal healthy patient



P2 a patient with mild systemic disease



P3 a patient with severe systemic disease



P4 a patient with severe systemic disease that is a
constant threats to life



P5 a moribund patient who is not expected to
survive without the operation



P6 a declared brain dead patient who’s organs are
being removed for donor purposes

QUALIFYING CIRCUMSTANCES


+99100 – Anesthesia for patient of extreme age,
younger than 1 year and older than 70 – 1 extra
unit.



+99116 – Anesthesia complicated by utilization of
total body hypothermia – 5 extra units.



+99135 – Anesthesia complicated by utilization of
controlled hypotension – 5 extra units.



+99140 - Anesthesia complicated by emergency
condition (specify) – 2 extra units.

QUALIFYING CIRCUMSTANCES


Documentation must support the qualifying
circumstance code reported. An emergency is
defined as existing with a delay in the treatment
of the patient with lead to a significant increase
in a threat to the patients life or body parts.



Highlight parenthetical notes pertaining to use of
qualifying circumstance codes with the CPT codes
for anesthesia service. For example, following
code 0036, it states “DO NOT REPORT 00326 in
conjunction with 99100”.

CPT MODIFIERS
Modifier 23 Unusual Anesthesia


Describe a procedure usually not requiring
anesthesia, but, due to unusual circumstances, is
performed under general anesthesia. For
example, a pediatric patient may require general
anesthesia for the surgeon to perform a
procedure not requiring anesthesia under usual
circumstances.

CPT MODIFIERS
Modifier 47 Anesthesia by Surgeon


It should not be appended to anesthesia codes
(00100-01999).

CPT MODIFIERS
Modifier 53 Discontinued Procedure
Describe

a procedure started and,
due to extenuating circumstances,
discontinued.

CPT MODIFIERS
Modifier 59 Distinct Procedural Service
This

modifier is often appended to
post pain operative management
services to indicate it is separate
from the anesthesia administered
during the surgery.

CPT MODIFIERS
Modifier 73 Discontinued Out –
Patient Hospital – ASC procedure
prior to administration of
anesthesia

CPT MODIFIERS
Modifier 74 Discontinued OutPatient Hospital - ASC
procedure after to
administration of anesthesia

DIRECTION, SUPERVISION AND MONITORING






Medical direction occurs when an anesthesiologist is involved in 2,3 or 4
anesthesia procedure at the same time; or a single anesthesia procedure with
a qualified anesthesia residence, CRNA, or AA.
According to the centers, for Medicare and Medicaid services, when an
anesthesiologist is medically directing, he or she must:
1.

Perform a pre anesthetic assessment and evaluation

2.

Prescribe an anesthesia plan

3.

Personally participate in the most demanding procedures of the anesthesia plan
including, if applicable, induction and emergence

4.

Ensure that the all the procedure in the anesthesia plan that he/ she does not
perform are performed by a qualified anesthetist

5.

Monitor the course of anesthesia administration at frequent intervals

6.

Remain physically present and available for immediate diagnosis and treatment
of emergencies

7.

Provide the indicated post anesthesia care.

If one or more of the above services is not performed by the
anesthesiologist, the service is not considered medical direction.

DIRECTION, SUPERVISION AND MONITORING


While medically directing, the anesthesiologist should not
provide services to other patient. However, anesthesiologist
are allowed to provide the following to other patient without
affecting their ability to provide medical direction:


Addressing an emergency in short duration in the immediate
area



Administering in epidural or caudal anesthetic to ease labor
pain



Periodic rather than continuous monitoring of an obstetrical
patient



Receiving patient entering the operating suite for the next
surgery



Checking on discharging patient from the post anesthesia unit



Coordinating scheduling matters

DIRECTION, SUPERVISION AND
MONITORING
 MAC

is the intra – operative monitoring by
an anesthesiologist or qualified individual
under the direction of an anesthesiologist
of a patient vital physiological signs, in
participation of:
 The

need for administration of general anesthesia;

 Development

of advance physiological reaction to
the surgical procedure

DIRECTION, SUPERVISION AND MONITORING
 Includes

the performance of the following by the

anesthesiologist or qualified individual under the
direction of an anesthesiologist;
1.

Pre anesthetic examination and evaluation

2.

Prescription of the anesthesia care required

3.

Completion of an anesthesia record

4.

Administration of any necessary oral and parenteral
medications

5.

Provision of indicated post operative anesthesia
care

HCTCS LEVEL 2 MODIFIERS


AA – anesthesia services performed personally by
anesthesiologist



AD – medical supervision: more than 4 concurrent
anesthesia procedure



QA – medical direction of 2,3 or 4 concurrent
anesthesia procedure involving individuals



QY – medical direction of CRNA by an anesthesiologist



GC – this service has been performed in part by a
resident under the direction of a teaching physician

HCTCS LEVEL 2 MODIFIERS
 Most

anesthesia modifier are reported only
with anesthesia codes; they are not listed
with others CPT code categories.

THANK YOU
FOR LISTENING!!

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