AAPC-Anesthesia-Chap14-GMcElhan – Flashcards
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How are anesthesia codes grouped?
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Anatomically, beginning with the head
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How are most anesthesia codes reported?
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by anatomic area
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What are the 3 primary types of anesthesia?
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1) General 2) Regional 3) Monitored Anesthesia (MAC)
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Drug-induced loss of consciousness?
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General Anesthesia
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Loss of sensation in a region of the body?
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Regional anesthesia
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What are 3 areas of regional anesthesia?
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1) Spinal anesthesia; 2) Epidural anesthesia; 3) Nerve Block or Local Nerve Block
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MAC?
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Monitored Anesthesia Care
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Anesthesia service where the patient is under a light sedation or no sedation while undergoing surgery with local anesthesia provided by the surgeon?
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Monitored Anesthesia Care (MAC)
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Under MAC the patient can do what?
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respond to purposeful stimulation and can maintain his airway
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MAC is provided by an anesthesia provider who is prepared to do what at all times?
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convert MAC to general anesthesia if necessary
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Which anesthesia is not reported using anesthesia codes?
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Local anesthesia is included in the surgical package and not reported separately
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What are the qualifications of an anesthesiologist?
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a physician licensed to practice medicine and who has completed an accredited anesthesiology program
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What 3 things are anesthesiologists allowed to do?
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1) personally perform anesthesia; 2) medically direct; 3) medically supervise members of an anesthesia care team
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CRNA?
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Certified Registered Nurse Anesthetist
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How does a registered nurse become a CRNA?
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by completing an accredited nurse anesthesia training program
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Can a CRNA function independently of a doctor?
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Yes, the CRNA can be medically directed by an anesthesiologist or NON-medically directed
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What is an AA?
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Anesthesiologist Assistant; is a healthcare professional who has completed an accredited Anesthesia Assistant training program
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Can an AA function independently?
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No, an AA may only be medically directed by an anesthesiologist
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What is an anesthesia resident?
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A physician who has completed his medical degree and is currently in a residency program specifically for anesthesiology training
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What is a SRNA?
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Student Registered Nurse Anesthetist; a registered nurse training in an accredited nurse anesthesia program
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One lung is ventilated and the other lung is collapsed temporarily to improve surgical access to the lung?
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One-Lung Ventilation (OLV)
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Are there more than one code for OLV?
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Yes, several anesthesia codes separately identify utilization of one-lung ventilation
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When a cardiopulmonary bypass (CPB) machines is used to function as the heart and lungs during heart or great vessel surgery?
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Pump Oxygenator
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Within the peritoneal cavity?
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Intraperitoneal
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What 7 organs are in the upper intraperitoneal cavity?
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1) stomach; 2) liver; 3) gallbladder; 4) spleen 5) jejunum; 6) ascending colon; 7) transverse colon
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What 4 organs are in the lower intraperitoneal cavity?
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1) appendix; 2) cecum; 3) ileum; 4) sigmoid colon
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Outside the peritoneal cavity?
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Extraperitoneal
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Behind the peritoneal cavity?
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Retroperitoneal
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Extensive and complex surgery intended to correct a severe health threat such as cancer?
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Radical
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Performed on the temporormandibular joint, shoulder, elbow, wrist, hip, knee, and ankle?
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Diagnostic or Surgical Arthroscopic Procedures
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If an Arthroscopic is diagnostic only, what do coders assign?
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Diagnostic codes only
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If a knee arthroscopy is listed as diagnostic and meniscectomy is performed what type of code is assigned?
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a surgical arthroscopic code
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How is postoperative pain management when requested by the surgeon billed by the anesthesiologist?
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It is billed separately if anesthesia for the surgical procedure is not dependent on the efficacy of the regional anesthetic technique.
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When are Nerve Block codes not reported separately?
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If the Nerve Block IS the mode of anesthesia for a procedure
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What 3 things does coding depend on?
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1) the medication injected; 2) the site of the injection; 3) placement of either a single injection or a continuous block by catheter.
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What modifier is used to signify a service is separate and distinct from anesthesia care provided for the surgery?
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Modifier 59
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What modifier is used when ultrasound or fluroscopic guidance is utilized for pain management?
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Modifier 26 (Professional component); unless the code includes image guidance
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Daily hospital management of continuous epidural or subarachnoid drug administration cannot be reported on the day of the catheter placement, when can it be reported?
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The first postoperative day
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What 4 services are included with the base unit value of anesthesia codes?
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1) All usual preoperative and postoperative visits; 2) Anesthesia care during the procedure; 3) Administration of fluids and/or blood products during the surgery; 4) Non-invasive monitoring
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What are unusual forms of monitoring not included in the base unit value of the anesthesia code?
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1) arterial lines; 2) central venous (CV) catheters; 3) pulmonary artery cathers (eg. Swan Ganz)
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When does anesthesia time begin?
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when the anesthesiologist begins to prepare the patient for anesthesia
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When does anesthesia time end?
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When the patient is safely placed under postoperative supervision
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What does Medicare require for time reporting?
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exact time without rounding to the nearest 5 minutes
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How does Medicare divide anesthesia time?
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By 15 minute increments which is then multiplied by the Anesthesia Conversion Factor
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How other insurance companies process the anesthesia time?
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They may report it in increments
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How many anesthesia codes are reported?
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Usually only one except if there is an add-on code such as Burn, Excision or Debridement and Obstetric
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An anesthesia add-on code assigned to report anesthesia services performed under difficult circumstances affecting significantly the character of an anesthesia service?
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Qualifying Circumstances (QC)
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When may an anesthesia provider bill for an additional code?
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When an invasive monitoring device is placed
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When can emergency intubation be reported?
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When an anesthesia provider is requested to intubate a patient who is NOT undergoing anesthesia: Code 31500
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Pertains to any medical procedure where access to inner organs or other tissue is done via needle- puncture of the skin? (rather than an open approach where the inner organs are exposed)
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Percutaneous
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What type of sedation can be provided by a physician?
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Moderate sedation
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What modifier is used to report a procedure usually not requiring anesthesia, but due to unusual circumstances is performed under general anesthesia?
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Modifier 23 - Unusual anesthesia
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What are anesthesiologists not allowed to do while medically directing?
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In general they should not provide services to other patients although they are allowed certain exceptions
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Anesthesia services performed personally by anesthesiologist?
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HCPCS Level II Modifier AA
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Medical supervision by a physician: More than 4 concurrent anesthesia procedures?
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HCPCS Level II Modifier AD
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Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals?
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HCPCS Level II Modifier QK
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Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist?
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HCPCS Level II Modifier QY
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This service has been performed in part by a resident under the direction of a teaching physician?
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HCPCS Level II Modifier GC
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CRNA service: With medical direction by a physician?
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HCPCS Level II Modifier QX
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CRNA service: Without medical direction by a physician?
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HCPCS Level II Modifier QZ
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How are most anesthesia modifiers reported?
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Only with anesthesia codes; they are not listed with other CPT code categories
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A flow-directed catheter inserted into the pulmonary artery?
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PAC - Pulmonary Artery Catheter (eg, Swan-Ganz)
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What are PACs used to measure?
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pressures and flows within the cardiovascular system
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A direct measurement of the blood pressure in the right atrium and vena cava?
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Central Venous Pressure (CVP)
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What does CVP reflect?
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The amount of blood returning to the heart and the ability of the heart to pump blood from the right heart into the pulmonary system
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A catheter inserted into an artery, used most commonly to measure real-time blood pressure and obtain samples for arterial blood gas?
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Arterial Line
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A catheter placed in a large vein such as the internal jugular, subclavian, or femoral vein with the tip of the catheter close to the atrium, or in the right atrium of the heart?
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Central Venous Catheter
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Deliberate reduction of a patient's total body temperature, reducing the general metabolism of the tissues?
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Total Body Hypothermia
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What should a coder watch for in the anesthesia record for Total Body Hypothermia?
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Temperature is reduced 20 percent to 30 percent below a patient's normal temperature. This is NOT reported separately when the code indicates it is included.
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An epidural is considered which type of anesthesia?
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Regional
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What is separately billable and is NOT included in anesthesia services?
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Introduction of an arterial line
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How are anesthesia services reported when one or more procedure is performed during the surgical session?
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Only ONE code is reported: The code for the most complex procedure is reported.
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When reporting code 99468-99476 what is included with these codes?
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See list on Pg. 43 of CPT manual for procedures included with these codes--Endotrachael intubation: 31500 is included and should not be billed separately
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Local coverage decisions are published to give providers information for what purpose?
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Medical necessity exclusions to coverage
