Coding Block 2/Anesthesia – Flashcards

loss of the ability to feel pain, with or without the loss of consciousness, induced by the administration of a drug or other medical intervention.

The management of procedures for rendering a patient insensible to pain and emotional stress during surgical, obstetrical, and certain medical procedures. The evaluation of management of life functions under the stress of anesthetic and surgical manipulations. The clinical management of the patient unconscious from whatever cause. The evaluation and management of problems in pain relief. The management of problems in cardiac and respiratory resuscitation. The application of specific methods of respiratory therapy. The clinical management of various fluid, electrolyte, and metabolic disturbances.*

Preoperative and postoperative visits by the anesthesiologist, anesthesia care during the procedure (e.g., general, regional, and local anesthesia), and the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry) are all bundled into the anesthesia code. No additional codes are necessary to describe these services.

Unusual forms of monitoring (e.g., intra-arterial, central venous, and Swan-Ganz) are reported with the use of additional codes.

The codes 99143-99145 are reported when a physician provides both the moderate conscious sedation and the procedure. However, if the moderate conscious sedation is included in the procedure, these codes may not be reported separately. (See Appendix G of the CPT® codebook.) In fact, don't just see Appendix G, read the details under Appendix G. When a second physician provides the moderate conscious sedation in a facility setting, then the second physician may report the codes 99148-99150. However, when services are provided by the second physician in a non-facility setting, these codes are not reported.

When the physician administers regional or general anesthesia and performs the surgery, the modifier 47 (anesthesia by surgeon) is appended to the appropriate procedure code. Modifier 47 is added to the surgical code, not the anesthesia code. You may remember this from your study of Modifiers back a few units.

Anesthesia services are reimbursed based in part on the amount of minutes and hours the anesthesia is administered. The reporting of time for anesthesia services varies by geographic location. The amount of time spent administering anesthesia is an important part of the reimbursement of anesthesia services. This will be discussed in detail in an upcoming lesson. Anesthesia time is usually documented as part of the operative procedure.

Physician's Services is a reminder to the coder to use E/M codes when appropriate and use anesthesia codes when appropriate. Just because an anesthesiologist is providing the service does not mean the report is assigned an anesthesia code. If the service provided by the anesthesiologist is not administering anesthesia or under the umbrella of administering anesthesia (pre-/post-operative visits, administration of anesthesia, anesthesia care during procedure, administration of fluids, etc.), then an E/M code would be the appropriate code and not an anesthesia code.

Materials supplied by the physician works the same for coding and billing anesthesia services as for coding and billing other physician services. If an anesthesiologist uses materials and supplies provided by the facility, the facility bills those materials and supplies. However, if the anesthesiologist uses materials and supplies provided by the anesthesiologist, he or she may code and bill for those supplies using the appropriate CPT and HCPCS codes. Find code 99070 in the "Numeric Section" and read the detailed code description. Additional HCPCS codes may also be reported if appropriate.

When multiple procedures are performed during the same operative session under the same type of anesthesia, the anesthesia code associated with the most complex procedure is assigned. Separate anesthesia codes do not need to be assigned for each procedure. The amount of time reported when multiple procedures are performed is the combined time for all the procedures. The record will document an anesthesia start time and anesthesia stop time. The anesthesia time encompasses the entire process—from the induction of anesthesia to the transfer of patient from anesthesia care to postoperative care.

Anesthesia services are reimbursed based in part on the amount of time anesthesia is administered. - True The anesthesia code for the most complex procedure is assigned when multiple procedures are performed during the same operative session under the same type of anesthesia -True Preoperative and postoperative visits by the anesthesiologist can be reported in addition to the administration of the anesthesia - False When a second physician provides moderate conscious sedation in a nonfacility setting then this physician can report a moderate conscious sedation code - False When a physician performs the surgery and administers the anesthesia the modifier 47 needs to be appended to the procedure code - True

The special report guideline should be starting to sound familiar to you. When circumstances are outside the ordinary or unusual, special reports are submitted to third-party payers documenting the nature, extent, and need for the procedure, as well as the time, effort, and equipment necessary to perform the procedure. Read the Special Report Section of the Anesthesia Guidelines for a list of information to be included in a special report and a list of additional items that may be required.

Read Anesthesia Modifiers and Physical Status Modifiers in the Anesthesia Guidelines. You have already had significant exposure to modifiers. Anesthesia is unique because ALL anesthesia services are reported by use of a code + a modifier. Physical Status Modifiers provide additional information about the physical status of the patient at the time of anesthesia. As you can imagine, the level of skill and care needed to attend an otherwise healthy patient during anesthesia is significantly different than the level of skill and care required to attend a patient who is not expected to survive without the procedure!

The last section in Anesthesia Guidelines deals with Add-on Codes. As you read about Qualifying Circumstances, think about what you already know about Add-on Codes from your study of the Instructions for Use of the CPT® Codebook. Add-on Codes provide additional information about the reported procedure code. Add-on Codes must always be provided in conjunction with another code. Add-on Codes are designated by a + symbol. Add-on Codes are listed in Appendix D. In anesthesia coding, Add-on Codes give important additional information when anesthesia is provided under extraordinary conditions.

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 threat to life P5: A moribund patient who is not expected to survive without the operation P6: A declared brain-dead patient whose organs are being removed for donor purposes

Physical Status Modifiers provide additional information about the physical status of the patient at the time of anesthesia administration - True Turn to the Qualifying Circumstances Guideline and read the description of each code. The code 99140 is reported when anesthesia is complicated by utilization of controlled hypotension - False The Physical Status Modifier P4 is reported for a patient with severe systemic disease that is a constant threat to life - True Qualifying Circumstance Codes must always be reported in conjunction with an anesthesia code - True The Physical Status Modifier P2 is reported for a patient with severe systemic disease - False

Anesthesia Formula: basic units + time units + modifying units (B + T + M) = total units total units x anesthesia conversion factor = reimbursement

The American Society of Anesthesiologists (ASA) publishes a Relative Value Guide (RVG) listing the codes for anesthesia services. The ASA Relative Value is not a fee schedule (a list of the charges for services). The RVG is used to compare anesthesia services to each other. Physicians with expertise in anesthesiology developed the comparison and assigned numerical values to each service. These numeric values are called basic unit value. When multiple surgical procedures are performed during the same operative session, the procedure with the highest basic unit value is reported. For example, during the same operative session, if a cervical cerclage (basic unit value of 4) and a total hip arthroplasty (basic unit value of 8) were performed, the basic unit value for reporting both procedures would be 8.

The next element of the formula is time. Anesthesia services are provided based on the amount of minutes and hours the anesthesia was administered. The time begins when the anesthesiologist begins preparing the patient to receive anesthesia and ends when the patient is no longer under the care of the anesthesiologist. The total time (minutes and hours) the anesthesia was administered must be recorded in the patient's medical record. Insurance companies determine the amount of time in units. Most insurance companies use 15 minutes as 1 unit.

Modifying units reflect circumstances or conditions that change or modify the environment in which the anesthesia service is provided. The two types of modifying units are Physical Status Modifiers and Qualifying Circumstances. The American Society of Anesthesiologists (ASA) assigns the six levels of physical status a relative value: **I attached a picture in the folder for Anesthesia under CPT coding in Documents> Computer

attached a picture in documents>coding block 2>anesthesia>anesthesia formula

Once total relative value units have been calculated, the final step in determining anesthesia reimbursement is multiplying the relative value unit x the appropriate anesthesia conversion factor. Anesthesia Formula: basic units + time units + modifying units (B + T + M) = total units total units x anesthesia conversion factor = reimbursement **Attached Picture in Anesthesia Folder

Other modifiers apply to the anesthesia codes in addition to the Physical Status Modifiers. Some third-party payers require additional modifiers to indicate how many cases an anesthesiologist is performing or supervising at one time. When an anesthesiologist is directing the administration of anesthesia for more than one case at a time, modifiers are used to indicate the number of cases that are concurrently being billed. The following are examples of the most commonly used modifiers: AA Anesthesia services performed personally by anesthesiologist AD Medical supervision by a physician for more than four concurrent anesthesia services QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals QS Monitored anesthesia services QX Certified registered nurse anesthetist (CRNA) service with medical direction by a physician QY Certified registered nurse anesthetist (CRNA) and anesthesiologist are involved in a single procedure and the physician is performing the medical direction QZ Certified registered nurse anesthetist (CRNA) service without medical direction by a physician These modifiers are located in the introduction of the HCPCS Level II codebook.

You may also find it very helpful to pull information into one place for easy reference. For example, grab a pencil and write relative values for Physical Status Modifiers and Qualifying Circumstances in the Anesthesia Guidelines next to their descriptions. P1 - 0 P2 - 0 P3 - 1, and so forth. You may also want to write the anesthesia reimbursement formula on the Anesthesia Guideline page as well for easy reference. Since the Anesthesia Modifiers are listed in the HCPCS book instead of the CPT code, grab your HCPCS book and open to Appendix 2 OR go back a lesson or two and write the Anesthesia Modifiers in the Anesthesia Guidelines for easy reference: AA - anesthesiologist performed AD - more than four concurrent procedures, etc.

Anesthesia Code Assignment: -Carefully read and review the medical record -Find the code in the CPT Index -Verify the code in the Anesthesia Numeric List -Review and select appropriate Anesthesia Modifier -Add the appropriate Physical Status Modifier as documented by the anesthesiologist -Review the record for any special circumstances requiring an Appendix A modifier -Review the record for any Qualifying Circumstances and, if necessary, select a Qualifying Circumstances code -Assign anesthesia code Calculate Reimbursement: -Calculate time unit (1 point per 15 minutes of anesthesia time) -Locate the basic value unit with the highest value -Calculate modifying unit (Physical Status Modifier value + Qualifying Circumstances value) -Calculate total units (B + T + M) -Calculate reimbursement using anesthesia conversion factor

Anesthesia for circumcision, performed by anesthesiologist personally. 00920-AA Add the appropriate Physical Status Modifier as documented by the anesthesiologist. If this information does not appear with the record, you will need to ask the anesthesiologist. In our case, it's part of the record. Physical Status Modifier P1. The procedure is usually done without a general anesthesia but due to "discomfort," general anesthesia was done. Modifier 23 describes this. Add Modifier 23 to your scratch paper. Anesthesia for circumcision, performed by anesthesiologist personally, in a normal healthy patient; anesthesia not normally used for this procedure. 00920-AA-P1-23 With the coding portion done, let's move on to the reimbursement portion. Calculate time unit (T) (1 point per 15 minutes of anesthesia time). Documented anesthesia time is 30 minutes, which converts to two 15 minute blocks. Each 15 minute block = 1 point; therefore, time unit is 2. Locate the basic value unit (B) with the highest value. In this case, the patient only had one procedure, so the procedure value for the circumcision procedure is the only value to consider. In practice, you would find the basic value unit in the RVG guide. Basic value unit = 9. Transfer 9 to your scratch paper as well. Calculate modifying unit (M) (Physical Status Modifier value + Qualifying Circumstances value). Physical Status Modifier P1 has a value of 0. No Qualifying Circumstances also has a value of 0. With the third piece of the formula, you are now ready to calculate the total units. Calculate total units (B + T + M) 00920 basic unit value = 9 Time unit (30 minutes) = 2 Modifying units = 0 9 + 2 + 0 = 11 Calculate reimbursement using anesthesia conversion factor. Total units (11) x anesthesia conversion factor (19.25) = $211.75