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Anesthesia

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Loss of sensation... administered to patients to relieve pain brought on by any number of causes, including surgery. - can be administered by a qualified professional thru injuection, inhalation and agent instillation.

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Anesthesiologist

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A physician qualified to administer anesthesia and who is board certified.

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Balanced Anesthesia

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anesthesia delivered by a combination of inhalation, injection, and instillation

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Base Unit

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reflects the usual services attached to anesthesia and the value of the work associated with the anesthesia services provided; also called basic value or relative value...

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base unit value

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reflects the usual services attached to anesthesia and the value of the work associated with the anesthesia services provided; also called basic value or relative value...

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basic value (relative value, base unit)

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- Usual services attached to anesthesia services - Value of work associated with anesthesia services

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Bier blocks

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injections of an anesthetic agent into the arm below the elbow, or in the leg below the knee

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block anesthesia / block

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a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity. Also called Conduction anesthesia

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block anesthesia

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...

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bundled

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preoperative, postoperative, and the service itself are included in the price the physician receives for the procedure

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certified Registered Nurse Anesthetist (CRNA)

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a registered nurse with 36 months additional training in anesthesiology who is certified to administer anesthesia

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conduction anesthesia

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a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity

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conscious sedation

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a method of anesthetizing the patient that causes a controlled state of depressed consciousness; also called moderate sedation

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epidural anesthesia

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injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...

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epidural blocks

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injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...

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general anesthesia

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anesthesia that affects the whole body causing a loss of consciousness

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General Anesthesia provided by a physician also performing services for which anesthesia is being provided

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See modifier 47 in Appendix A

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inhalation

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when a substance is moved through the respiratory and / or circulatory systems

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injection

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substance administered directly into the blood-stream, subcutaneous tissue, or intramuscular

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instillation

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introduction into a body cavity that has a mucous membrane

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intraspinal anesthesia

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* Epidural - Injected above the Dura Mater in the spinal column

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local anesthesia

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* Topical, rubbed on skin or subcutaneous - for Dental or minor surgical procedures

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moderate sedation (conscious) administered by same physician performing procedure

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*Form of anesthesia that causes controlled state of depressed consciousness; Pt. able to respond to stimulation. Use codes: 99143-99145 for Same physician administering and performing service

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Moderate (conscious), sedation administered by second physician other than one performing therapeutic service, in facility setting (hospital, surgery center etc):

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Second Physician reports the associated moderate sedation procedure / service code: 99148-99150

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Moderate (conscious) sedation does NOT INCLUDE:

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minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (00100-01999)

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When moderate (conscious) sedation is administered in the NONfacility setting (physician office, freestanding imaging center) by second physician:

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Codes 99148-199150 are NOT REPORTED!!!!

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modifying units

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- Determined by physical conditions and qualifying circumstances that affect administration of anesthesia - Sometimes conditions are unusual or out of the ordinary - Some things significantly impact administration of anesthesia

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peridural anesthesia

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injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid.

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physical status modifiers

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modifiers used to describe the patient's health status

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postanesthesia recovery period

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...

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qualifying circumstances

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Unusual or out of the ordinary conditions that significantly influence the administration of anesthesia. **Reported using codes 99100-99140 ***Require an additional qualifying circumstance code to be reported w/ the anesthesia service code. ** Medicare doesn't recognize the qualifying circumstances codes. **Qual Circ. codes are never to be used alone! -QC codes are located in the Medicine section of CPT & explained under in Anesthesia Guidelines section.

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regional anesthesia

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anesthesia in which a particular body area or region is anesthetized

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relative value

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* Contains basic value of each anesthesia service and additional codes that act as supplements to regular CPT codes

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Relative value Guide (RVG)

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published by ASA (Amer. Soc. of Anesthesiologists) * Contains the basic value of each of the anesthesia services and additional codes that act as supplements to the regular CPT codes, along with narratives similar to those in the CPT book.

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spinal anesthesia

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injection of an anesthetic agent into the spinal area

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subarachnoid anesthesia

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injection of an anesthetic agent into the spinal area

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time unit (1 unit = 15 minutes); sometimes 30 minutes

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Independently determined by payers and represents * Actual time spent providing anesthesia services - Starts when provider is in personal attendance to prepare pt. for induction - Ends when provider is no longer in attendance * Represents defined time increment - Usually 15 minutes

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Scenarios for the delivery of anesthesia services are:

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- anesthesiologist performing services alone - cert. registered nurse anesthetist performing services alone - anesthesiologist directing one cert. registered nurse anesthetist - anesthesiologist directing multiple CRNAs performing concurrent procedures.

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Types of Anesthesia

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- General Anesthesia (loss of consciousness) - Regional Anesthesia / Block or conduction anesthesia - anesthetizes a region or area of the body by nerve or field blocking - Local Anesthesia - numbs a small area (finger, toe) agent applied topically to skin or injected subcutaneously. (dental, brief surgical)

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Anesthesia Time Reporting

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Customary to report time for Local Anesthesia Procedures - begins when anesthesiologist begins prep patient for induction of anesthesia in operating room - ends when anesthesiologist is no longer in personal attendance (pt. is under post-op supervision)

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Anesthesia Services

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- Services rendered in office, home, or hospital; consultation & other medical services... - Listed in the Evaluation and Management Services section 99201-99499 - Special Services and Reporting are listed in Medicine section; 99000-99091

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Supplied Materials

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Use Code = 99070 or appropriate Supply code. - Drugs, tray supplies and materials provided

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Excess Supplies and Materials (over and above those usually included w/ office visit)

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Extra Supplies / Materials.... listed separately

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Separate or Multiple Procedures

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- When multiple surgical procedures are performed during a single anesthetic administration... the anesthesia code representing the most complex procedure is reported. - Time reported is combined total for all procedures.

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Special Report

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A service that's rarely provided - unusual, variable, or new may require a special report. - It should include a definition or description of nature, extent, need for procedure AND - time, effort & equipment necessary to provide the service

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Anesthesia Service Reporting

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All anesthesia services are reported by use of the anesthesia five-digit procedure code (00100-01999) PLUS the addition of a physical status modifier. - The use of other optional HCPCS modifiers may be appropriate as well; in use for Medicare & some third-party payers

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Physical Status Modifiers

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- Modifiers added after 5-digit anesthesia code to describe patient's health - represented by the initial letter 'P' followed by a single digit from 1 to 6 as defined below: - P1 = normal healthy pt. - P2 = pt. w/ mild systemic disease - P3 = pt. w/ severe systemic disease - P4 = pt. w/ severe systemic disease that's constant threat to life - P5 = moribund pt. not expected to survive w/out the operation - P6 = declared dead pt. whose organs are being removed for donor purposes

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When Billing Anesthesia... make sure:

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- Anesthesiologist bills services separately from surgeon - Charges must mirror charges submitted by surgeon - Must use same diagnosis code - Must use same procedure code

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How to Locate Anesthesia Procedure Codes:

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1. Main term to reference in Index: ie - Anesthesia 2. Index then divided by: a. TYPE of procedure performed b. BODY SITE of procedure 3. Index contains very general or very specific codes

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Anesthesia for Radiological Procedures

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- Code Range 01916-01936

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Anesthesia for Burn Excisions or Debridement

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- Code Range of 01951 - 01993

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Anesthesia for Obstetrics

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- Code Range of 01958 - 01969

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Anesthesia for Other Procedures

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- Code Range of 01990 - 01999

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Modifier 47 to report:

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- Surgeon who administered regional or general anesthesia ** do NOT use as modifier for anesthesia procedures!!

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HCPCS Level II modifiers:

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- alpha modifiers used by Medicare and some other payers

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HCPCS Level II Modifiers List:

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* AA - anesthesia services by anesthesiologist * AD - supervision of more than four concurrent anesthesia procedures; used by anesthesiologist * G8 - MAC for deep complex, complicated or markedly invasive surgical procedure * G9 - Monitored anesthesia care for a pt. who has a history of a severe cardiopulmonary condition

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Calculating Anesthesia Charges: Terms and Formula:

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** MUST BE ABLE TO DEFINE TERMS TO UNDERSTAND FORMULA: Basic Value + Time Units + Modifying Units = Total Units Total Units X Conversion Factor = Total Fee

CPT Ch. 4 Anesthesia – Flashcards

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