1. Anesthesia

2. Objectives: Identify questions requiring anesthesia codes
Eliminate incorrect codes
Determine how to properly use anesthesia codes.
This video will help you:
Identify questions requiring anesthesia codes
Eliminate incorrect codes
Determine how to properly use anesthesia codes.

3. Introduction Anesthesia used in surgery, medicine, radiology
Read guidelines
Anesthesia is used by all of the surgical specialties. It is administered for some medical procedures and even some radiological procedures. As with all CPT chapters, review the guidelines before assigning codes. Anesthesia has specific requirements with relation to physical status modifiers and qualifying circumstance add-on codes.

4. Key points Use only the highest paying code Don’t add multiple codes
Anesthesia codes are heavily dependant on modifiers
There are a few key points to remember when coding anesthesia services.
CMS dictates that you use only the highest-paying code for anesthesia.
Beware of adding multiple codes together. This is considered unbundling.
Anesthesia codes are heavily dependant on modifiers.

5. Identify Provider Anesthesiologist Surgeon
CRNA (Certified Registered Nurse Anesthetist); with or without supervision.
When coding for anesthesia, first identify the provider. A variety of professionals can apply these services.
The Anesthesiologist personally.
The Surgeon performing the services.
A CRNA (Certified Registered Nurse Anesthetist); with or without supervision.
You must establish who provided the service as this will help determine the proper code.

6. Provider Codes Modifier 47 appended to service
CRNA services without physician supervision Modifier QZ
Anesthesiologist services = modifier AA and physical status modifiers
If the surgeon applies regional or general anesthesia, refer to modifier 47 in the CPT manual. This is appended to the service code, not an anesthesia code.
If a CRNA provides services without physician supervision, refer to modifier QZ in the HCPCS manual.
If services are provided by the anesthesiologist, refer to modifier AA in the HCPCS manual in addition to the physical status modifiers in the CPT manual.

7. A straightforward example
A 24 year old professional athlete undergoes an arthroscopic evaluation of the right shoulder due to a dislocation of the joint during practice. He is in good health and has no other problems. Code the anesthesiologist’s component with appropriate modifier(s).
a AA-P1 c P1
b AA-P1 d P2
In this example, the physical status of the patient is a normal healthy male. Selection “d” can be eliminated due to the P2 modifier indicating a mild systemic disease. The AA modifier located in the HCPCS manual indicates the anesthesia was applied by the anesthesiologist. Therefore “c” can be eliminated as well. Finally, correct code look-up of the service involving the arthroscopic evaluation of the right shoulder in the CPT manual will point to “a” as the correct answer.

8. A little more complicated
A 72 year old man undergoes a cardiac catheterization with an angiogram to evaluate occlusion of the coronary artery. He has malignant hypertension and renal insufficiency. Code the anesthesiologist’s component with appropriate modifier(s).
a P1, c P4, 93501, 99100
b AA-P4, d P6, 99100
In this case, the patient presents with at least one severe systemic disease and the extreme age of 72. The only appropriate physical status modifier that applies to this patient’s condition is a P4. This eliminates choices “a” and “d.” The reference to code represents the cardiac catheterization. However, this is not a service the anesthesiologist would perform, so choice “c” can also be discounted. Code look up will lead to choice “b” as the only correct answer.

9. Read code descriptions
A 3 month old boy undergoes a mitral valve repair procedure due to a congenital defect. A pump oxygenator is utilized in this procedure. Without the procedure the child is not expected to survive. Code the anesthesiologist’s component with appropriate modifier(s).
a AA-P5 c P5, 99100
00561-P1, d P5, 99100
In this case, anesthesia administered to a 3 month old infant would seem to require an extreme age add on code (99100). However, the code description for in the CPT manual indicates not to use the qualifying circumstance code. Therefore “a” is the only appropriate choice.

10. Anesthesia rules
A healthy 24 year old woman undergoes an exploratory endoscopic procedure of her upper intestinal system. During the evaluation, it was noted she has a hernia of the duodenum. The decision was made to repair the hernia during the same operative session. Code the anesthesiologist’s component with appropriate modifier(s).
a AA-P2, P2 c AA-P1
b AA-P1, P1 d P1
The anesthesiologist can only charge the highest paying code when multiple procedures are performed during the same session. This eliminates “a” and “b” from the list of choices. A diagnostic endoscopy is bundled into the greater procedure and is not reported separately. In this case, the repair of duodenal hernia represents the more complicated procedure. This reveal’s “c” as the only appropriate choice.

11. Read thoroughly
A 71 year old man undergoes a total hip replacement. This patient has mild hypertension and Type II, well controlled diabetes. During the procedure his blood pressure drops dramatically and the situation is considered emergent. His blood pressure was brought under control and the procedure was completed without further incident. Code the anesthesiologist’s component with appropriate modifier(s).
a AA-P2, c AA-P2, 99100
b AA-P3, d AA-P2, 99100, 99140
Here the patient is described as becoming an emergency during the procedure in addition to requiring an extreme age add on code. The only answer describing both conditions is choice “d.”

12. Identify providers Narrow down choices Select code
Summary
Identify providers
Narrow down choices
Select code
As described, correct coding of anesthesia is a complicated process. However, understanding who provided the services and how to reference modifiers will easily point to the correct route to take.