CPT Ch. 4 Anesthesia – Flashcards

question
Anesthesia
answer
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.
question
Anesthesiologist
answer
A physician qualified to administer anesthesia and who is board certified.
question
Balanced Anesthesia
answer
anesthesia delivered by a combination of inhalation, injection, and instillation
question
Base Unit
answer
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...
question
base unit value
answer
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...
question
basic value (relative value, base unit)
answer
- Usual services attached to anesthesia services - Value of work associated with anesthesia services
question
Bier blocks
answer
injections of an anesthetic agent into the arm below the elbow, or in the leg below the knee
question
block anesthesia / block
answer
a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity. Also called Conduction anesthesia
question
block anesthesia
answer
...
question
bundled
answer
preoperative, postoperative, and the service itself are included in the price the physician receives for the procedure
question
certified Registered Nurse Anesthetist (CRNA)
answer
a registered nurse with 36 months additional training in anesthesiology who is certified to administer anesthesia
question
conduction anesthesia
answer
a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity
question
conscious sedation
answer
a method of anesthetizing the patient that causes a controlled state of depressed consciousness; also called moderate sedation
question
epidural anesthesia
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...
question
epidural blocks
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...
question
general anesthesia
answer
anesthesia that affects the whole body causing a loss of consciousness
question
General Anesthesia provided by a physician also performing services for which anesthesia is being provided
answer
See modifier 47 in Appendix A
question
inhalation
answer
when a substance is moved through the respiratory and / or circulatory systems
question
injection
answer
substance administered directly into the blood-stream, subcutaneous tissue, or intramuscular
question
instillation
answer
introduction into a body cavity that has a mucous membrane
question
intraspinal anesthesia
answer
* Epidural - Injected above the Dura Mater in the spinal column
question
local anesthesia
answer
* Topical, rubbed on skin or subcutaneous - for Dental or minor surgical procedures
question
moderate sedation (conscious) administered by same physician performing procedure
answer
*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
question
Moderate (conscious), sedation administered by second physician other than one performing therapeutic service, in facility setting (hospital, surgery center etc):
answer
Second Physician reports the associated moderate sedation procedure / service code: 99148-99150
question
Moderate (conscious) sedation does NOT INCLUDE:
answer
minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (00100-01999)
question
When moderate (conscious) sedation is administered in the NONfacility setting (physician office, freestanding imaging center) by second physician:
answer
Codes 99148-199150 are NOT REPORTED!!!!
question
modifying units
answer
- 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
question
peridural anesthesia
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid.
question
physical status modifiers
answer
modifiers used to describe the patient's health status
question
postanesthesia recovery period
answer
...
question
qualifying circumstances
answer
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.
question
regional anesthesia
answer
anesthesia in which a particular body area or region is anesthetized
question
relative value
answer
* Contains basic value of each anesthesia service and additional codes that act as supplements to regular CPT codes
question
Relative value Guide (RVG)
answer
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.
question
spinal anesthesia
answer
injection of an anesthetic agent into the spinal area
question
subarachnoid anesthesia
answer
injection of an anesthetic agent into the spinal area
question
time unit (1 unit = 15 minutes); sometimes 30 minutes
answer
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
question
Scenarios for the delivery of anesthesia services are:
answer
- 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.
question
Types of Anesthesia
answer
- 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)
question
Anesthesia Time Reporting
answer
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)
question
Anesthesia Services
answer
- 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
question
Supplied Materials
answer
Use Code = 99070 or appropriate Supply code. - Drugs, tray supplies and materials provided
question
Excess Supplies and Materials (over and above those usually included w/ office visit)
answer
Extra Supplies / Materials.... listed separately
question
Separate or Multiple Procedures
answer
- 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.
question
Special Report
answer
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
question
Anesthesia Service Reporting
answer
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
question
Physical Status Modifiers
answer
- 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
question
When Billing Anesthesia... make sure:
answer
- Anesthesiologist bills services separately from surgeon - Charges must mirror charges submitted by surgeon - Must use same diagnosis code - Must use same procedure code
question
How to Locate Anesthesia Procedure Codes:
answer
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
question
Anesthesia for Radiological Procedures
answer
- Code Range 01916-01936
question
Anesthesia for Burn Excisions or Debridement
answer
- Code Range of 01951 - 01993
question
Anesthesia for Obstetrics
answer
- Code Range of 01958 - 01969
question
Anesthesia for Other Procedures
answer
- Code Range of 01990 - 01999
question
Modifier 47 to report:
answer
- Surgeon who administered regional or general anesthesia ** do NOT use as modifier for anesthesia procedures!!
question
HCPCS Level II modifiers:
answer
- alpha modifiers used by Medicare and some other payers
question
HCPCS Level II Modifiers List:
answer
* 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
question
Calculating Anesthesia Charges: Terms and Formula:
answer
** MUST BE ABLE TO DEFINE TERMS TO UNDERSTAND FORMULA: Basic Value + Time Units + Modifying Units = Total Units Total Units X Conversion Factor = Total Fee
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question
Anesthesia
answer
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.
question
Anesthesiologist
answer
A physician qualified to administer anesthesia and who is board certified.
question
Balanced Anesthesia
answer
anesthesia delivered by a combination of inhalation, injection, and instillation
question
Base Unit
answer
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...
question
base unit value
answer
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...
question
basic value (relative value, base unit)
answer
- Usual services attached to anesthesia services - Value of work associated with anesthesia services
question
Bier blocks
answer
injections of an anesthetic agent into the arm below the elbow, or in the leg below the knee
question
block anesthesia / block
answer
a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity. Also called Conduction anesthesia
question
block anesthesia
answer
...
question
bundled
answer
preoperative, postoperative, and the service itself are included in the price the physician receives for the procedure
question
certified Registered Nurse Anesthetist (CRNA)
answer
a registered nurse with 36 months additional training in anesthesiology who is certified to administer anesthesia
question
conduction anesthesia
answer
a type of regional anesthesia in which anesthetic is injected along a major nerve tract, interrupting the nerve conductivity
question
conscious sedation
answer
a method of anesthetizing the patient that causes a controlled state of depressed consciousness; also called moderate sedation
question
epidural anesthesia
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...
question
epidural blocks
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid...
question
general anesthesia
answer
anesthesia that affects the whole body causing a loss of consciousness
question
General Anesthesia provided by a physician also performing services for which anesthesia is being provided
answer
See modifier 47 in Appendix A
question
inhalation
answer
when a substance is moved through the respiratory and / or circulatory systems
question
injection
answer
substance administered directly into the blood-stream, subcutaneous tissue, or intramuscular
question
instillation
answer
introduction into a body cavity that has a mucous membrane
question
intraspinal anesthesia
answer
* Epidural - Injected above the Dura Mater in the spinal column
question
local anesthesia
answer
* Topical, rubbed on skin or subcutaneous - for Dental or minor surgical procedures
question
moderate sedation (conscious) administered by same physician performing procedure
answer
*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
question
Moderate (conscious), sedation administered by second physician other than one performing therapeutic service, in facility setting (hospital, surgery center etc):
answer
Second Physician reports the associated moderate sedation procedure / service code: 99148-99150
question
Moderate (conscious) sedation does NOT INCLUDE:
answer
minimal sedation (anxiolysis), deep sedation, or monitored anesthesia care (00100-01999)
question
When moderate (conscious) sedation is administered in the NONfacility setting (physician office, freestanding imaging center) by second physician:
answer
Codes 99148-199150 are NOT REPORTED!!!!
question
modifying units
answer
- 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
question
peridural anesthesia
answer
injection of an anesthetic agent into the epidural space above the dura mater that contains the spinal nerves and cerebrospinal fluid.
question
physical status modifiers
answer
modifiers used to describe the patient's health status
question
postanesthesia recovery period
answer
...
question
qualifying circumstances
answer
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.
question
regional anesthesia
answer
anesthesia in which a particular body area or region is anesthetized
question
relative value
answer
* Contains basic value of each anesthesia service and additional codes that act as supplements to regular CPT codes
question
Relative value Guide (RVG)
answer
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.
question
spinal anesthesia
answer
injection of an anesthetic agent into the spinal area
question
subarachnoid anesthesia
answer
injection of an anesthetic agent into the spinal area
question
time unit (1 unit = 15 minutes); sometimes 30 minutes
answer
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
question
Scenarios for the delivery of anesthesia services are:
answer
- 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.
question
Types of Anesthesia
answer
- 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)
question
Anesthesia Time Reporting
answer
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)
question
Anesthesia Services
answer
- 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
question
Supplied Materials
answer
Use Code = 99070 or appropriate Supply code. - Drugs, tray supplies and materials provided
question
Excess Supplies and Materials (over and above those usually included w/ office visit)
answer
Extra Supplies / Materials.... listed separately
question
Separate or Multiple Procedures
answer
- 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.
question
Special Report
answer
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
question
Anesthesia Service Reporting
answer
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
question
Physical Status Modifiers
answer
- 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
question
When Billing Anesthesia... make sure:
answer
- Anesthesiologist bills services separately from surgeon - Charges must mirror charges submitted by surgeon - Must use same diagnosis code - Must use same procedure code
question
How to Locate Anesthesia Procedure Codes:
answer
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
question
Anesthesia for Radiological Procedures
answer
- Code Range 01916-01936
question
Anesthesia for Burn Excisions or Debridement
answer
- Code Range of 01951 - 01993
question
Anesthesia for Obstetrics
answer
- Code Range of 01958 - 01969
question
Anesthesia for Other Procedures
answer
- Code Range of 01990 - 01999
question
Modifier 47 to report:
answer
- Surgeon who administered regional or general anesthesia ** do NOT use as modifier for anesthesia procedures!!
question
HCPCS Level II modifiers:
answer
- alpha modifiers used by Medicare and some other payers
question
HCPCS Level II Modifiers List:
answer
* 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
question
Calculating Anesthesia Charges: Terms and Formula:
answer
** MUST BE ABLE TO DEFINE TERMS TO UNDERSTAND FORMULA: Basic Value + Time Units + Modifying Units = Total Units Total Units X Conversion Factor = Total Fee