1. CODING PROCEDURES Part II:
Chapter 6
CODING PROCEDURES Part II:
Anesthesia
Chapter 6

2. Coding Procedures & Services Anesthesia Section (00100-01999, 99100-99140)
Anesthesia is the administration of a drug or other anesthetic agent by injection or inhalation to obtain muscular relaxation, loss of sensation and/or loss of consciousness.
Anesthesia is classified according to the effect they have on the body.
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Chapter 6

3. Anesthesia Classification/Types & Examples:
Coding Procedures & Services Anesthesia Section ( , )
Anesthesia Classification/Types &
Examples:
Topical/Gel applied to the urethra for dilation
Included in surgical procedure (can not bill separately)
Local/ Subcutaneous injection to remove a nerve
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Chapter 6

4. Anesthesia Classification/Types & Examples: Cont.
Coding Procedures & Services Anesthesia Section ( , )
Anesthesia Classification/Types & Examples: Cont.
Regional/Epidural delivery injection used during labor & delivery
Not Included in surgical procedure (can bill separately)
General/Inhalation of a substance during tonsillectomy to render the patient totally unconscious
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Chapter 6

5. Anesthesia Subsections
Coding Procedures & Services Anesthesia Section ( , )
Arrangement
Anatomic Site where the Surgery is performed
Anesthesia Subsections
Divided by Anatomic Site, except:
Radiological Procedures - subsection is used when anesthesia is provided during a diagnostic or therapeutic radiologic service.
Burn Excisions or Debridement & Other Procedures - The Burn section is arranged according to percent of body surface area treated and used when surgery is performed to debride and/or clean a burn.
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Chapter 6

6. Research Anesthesia Codes by:
Coding Procedures & Services Anesthesia Section ( , )
Research Anesthesia Codes by:
Where - surgery was performed (anatomic site)
What - type of anesthesia administered
Who - provided the anesthesia (anesthesiologist, physician, etc)
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Chapter 6

7. Index/Anesthesia/Foot (anatomic part)
Coding Procedures & Services Anesthesia Section ( , )
To Find Anesthesia Code:
Bunionectomy
Index/Anesthesia/Foot (anatomic part)
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01462
Chapter 6

8. Coding Procedures & Services Anesthesia Section/Modifiers (00100-01999, 99100-99140)
Anesthesia Modifiers must be used with anesthesia procedure codes to indicate whether the procedure was:
Personally performed,
Medical directed or
Medically supervised.
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Chapter 6

9. AA - Anesthesia services personally performed by anesthesiologist.
Coding Procedures & Services Anesthesia Section/Modifiers ( , )
AA - Anesthesia services personally performed by anesthesiologist.
AD – Medical supervised by a physician
QK – Medical direction of two, to four concurrent anesthesia procedures involving qualified individuals
QS – Monitored anesthesia care
QX – CRNA service (Certified Registered Nurse Anesthetist)
QY – Medical direction of one CRNA by a physician
QZ – CRNA service; without medical direction by a physician
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Chapter 6

10. The Physical Status Modifier are located in the Anesthesia Guidelines.
Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )
The Physical Status is the condition of the patient at the time anesthesia was administered.
An Anesthesiologist determines the physical status of a patient & document the information in the Anesthesia record.
The Physical Status Modifier are located in the Anesthesia Guidelines.
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Chapter 6

11. P1-P6 (Physical Status Modifiers)
Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )
Modifiers
-47 (anesthesia by surgeon)
P1-P6 (Physical Status Modifiers)
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.
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Chapter 6

12. -23 – unusual anesthesia;
Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )
ASA (American Society of Anesthesiologists ) allows other medical modifiers to be used in anesthesia which include:
-22 – unusual services;
-23 – unusual anesthesia;
-25 – significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service;
-59 – distinct procedural service.
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Chapter 6

13. Qualifying Circumstances
Coding Procedures & Services Anesthesia Section/ Section/Qualifying Circumstances ( , )
Qualifying Circumstances
( )/Medicine Section
Located in the Anesthesia Guidelines
Identified by + symbol as an “add-on-code”.
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Chapter 6

14. Coding Procedures & Services Anesthesia Section/Billing Information (00100-01999, 99100-99140)
All ANESTHESIA VALUES are determined by taking the BASIC UNIT VALUE (which is related to the complexity of the service,) and;
TIME UNITS; plus
MODIFYING UNITS (if any),
The Fee/Payment for a particular procedure or service in the Anesthesia Section is determined by multiplying the listed "Basic Unit Value" by the Conversion Factor that is applicable to the section.
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Chapter 6

15. Anesthesia Payment & Billing Information
Basic Unit Value
Is the basis for determining the base points is the Relative Value Guide published by the American Society of Anesthesiologists (ASA).
Chapter 6

16. Anesthesia Payment & Billing Information
Time Units
Time Units will be determined by using the total time in minutes actually spent performing the procedure.
Fifteen Minutes is equivalent to one (1) time unit.
Time Units will be rounded to the tenth. Therefore, if the procedure lasted 49 minutes, the time units in this example would be 3.26 or 3.3 time units. (i.e., 49/15=3.26 or 3.3)
Chapter 6

17. Anesthesia Payment & Billing Information
Unit
Value(s)
Physical Status Modifiers – to be billed by Anesthesiologists and/or CRNAs P1
A normal healthy person P2
A patient with mild systemic disease P3
A patient with severe systemic disease 1 P4
A patient with severe systemic disease that is a constant threat
to life 2 P5
A moribund patient who is not
expected to survive without the operation 3 P6
A declared brain dead patient whose organs are being removed for donor purposes
Chapter 6

18. Anesthesia Payment & Billing Information
Unit Value(s)
Qualifying Circumstances to be billed by Anesthesiologists and/or CRNAs
+99100
Anesthesia for patients of
extreme age, under 1 year and over 70 (list separately in addition to code for primary procedure) 1
+99116
Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary procedure) 5
+99135
Anesthesia complicated by utilization of controlled hypotension (list separately in additional to code for primary procedure)
+99140
Anesthesia complicated by emergency conditions (specify) (list separately in addition to code for primary procedure) 2
Chapter 6

19. Conversion Factor – is the allowed amount assigned to the “Base Unit”.
Coding Procedures & Services Anesthesia Section/Calculating Anesthesia Time ( ,
Base Units
Base Unit Values have been assigned to each anesthesia procedure code and reflect the difficulty of the anesthesia service, including the usual pre-operative and post-operative care and evaluation.
Time Units
Time units is the time during which an anesthesia practitioner is present with the patient
Conversion Factor – is the allowed amount assigned to the “Base Unit”.
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Chapter 6

20. Coding Procedures & Services Anesthesia Section/Calculating Anesthesia Time ( , )
All anesthesia values are determined by taking the BASIC UNIT VALUE, which is related to the complexity of the service, and adding MODIFYING UNITS (if any), and TIME UNITS.
The Fee for a particular procedure or service is determined by multiplying the listed "Basic Unit Value" by the Conversion Factor Base = base units per anesthesia CPT coded. Obtained from the American Society of Anesthesiologists (ASA) 1988 Relative Value Guide
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FORMULA:
(Base Units + Times Units+ Modifying Units) x Conversion Factor = Allowance
Chapter 6

21. Calculating Anesthesia Time
Coding Procedures & Services Anesthesia Section/Calculating Anesthesia Time ( , )
Calculating Anesthesia Time
Anesthesia time is the time during which an anesthesia practitioner is present with the patient.
Time units are determined on the basis of one time unit for each 15 minutes of anesthesia.
Time Units
Round-up if five or more
Round-down if four or less
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Chapter 6

22. Example A (Round-down): Total anesthesia time = 95 minutes/15 = 6.3.
Coding Procedures & Services Anesthesia Section/Calculating Anesthesia Time ( , )
Example A (Round-down):
Total anesthesia time = 95 minutes/15 = 6.3.
95/3 = 6.3
Total time units claimed = 6
Example B (Round-up):
Total anesthesia time = 70 minutes/15 = 4.6.
70/15 = 4.6
Total time units claimed = 5
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Chapter 6

23. CALCULATION EXAMPLES:
Coding Procedures & Services Anesthesia Section/Calculating Anesthesia Time ( , )
CALCULATION EXAMPLES:
EXAMPLE 1: In a procedure with a Basic Unit Value of 3.0 requiring one hour and forty-five minutes of anesthesia time, the total value should be determined as follows:
Basic Unit Value = 3.0 units (ASA)
105 minutes÷15 minutes = 7.0 units (60+45=105)
Total value = 10.0 units
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Total Units * Conversion Factor = Maximum Allowable Fee
Example 1 – 10 Total Units * $48.75 (conversion factor) = $ (max fee)
Chapter 6

24. Coding Procedures & Services Anesthesia Section (00100-01999, 99100-99140)
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Chapter 6

25. Total Units * Conversion Factor = Maximum Allowable Fee
Calculating Anesthesia Time
EXAMPLE 2: In a procedure with a Basic Unit Value of 10.0 requiring four hours and twenty minutes of anesthesia time, the total value should be determined as follows:
Basic Unit Value = 10.0 units (ASA)
First four hour = 16.0 units
Subsequent 20 minutes = 4.0 units (10 Min. Increments)
Total value = 30.0 units
Total Units * Conversion Factor = Maximum Allowable Fee
Example Total Units * $48.75 (conversion factor) =$1, (max fee)
Formula:
(Base Units + Times Units+ Modifying Units) x Conversion Factor = Allowance - or
AF=(BUxCF)+(CFxTU)+(CF xM)
Chapter 6

26. Calculating Anesthesia Time
In both examples, the Maximum Allowable Fee is determined by multiplying the Total Value Units by the Conversion Factor.
The Basic Unit Value (showing the procedure code and all modifiers) and Time Units separately, as in the following:
Procedure code + Modifier(s) = Basic Unit Value
Anesthesia Time = Time Units
Total value = Total units
Chapter 6

27. Calculating Anesthesia Time
Procedure code + Modifier(s) = Basic Unit Value
Anesthesia Time = Time Units
Total value = Total units
Procedure code + Modifier(s) = Basic Unit Value
Procedure Code
Basic Unit Value
00100
5+TM
Anesthesia Time = Time Units
1 Hour 30 minutes = 6 Time Units
Total value = Total units
Basic Units = Time units = 11 Total Units
Total Units x Conversion Factor = Maximum Allowable Fee
Total Units = 11 x $48.70 = Conversion Factor = $ Max allowed
Chapter 6

28. Anesthesia Coding Steps
Step 1: Identify anesthesia procedure/service
Step 2: Assign physical status modifier
Step 3: Assign qualifying circumstance, if applicable
Step 4: Assign modifier codes, if applicable
Step 5: Calculate anesthesia time
Chapter 6

29. Applying the Concepts  Cornea Transplant
Identify the needed components for assigning anesthesia codes and appropriate modifiers in the procedure below:
 Cornea Transplant
Chapter 6

30. Applying the Concepts Step 1: Identify anesthesia procedure/service
Corneal transplant
Subsection: Head
Anesthesia procedures on eye: Corneal transplant
Code:
Chapter 6

31. Applying the Concepts Step 2: Assign physical status modifier
No medical conditions listed, therefore
Physical status modifier = P1
Normal healthy patient with no risks
Step 3: Assign qualifying circumstance, if applicable
 No qualifying circumstances identified; therefore, none assigned
Chapter 6

32. Applying the Concepts Step 4: Assign modifier codes, if applicable
 No extenuating circumstances identified that require assignment of a modifier code
Chapter 6

33. Calculating Base Units
Anesthesiology Unit Values Rate is $37.02 per unit Rates for time based codes are calculated using base units plus time spent
Code
Base Units
Max Allowed
Total Time
00144 6
1 Hr. 30 (90 min)
90/15 = 6/(Base unit only)
Anesthesia’s time = 1hr 45 min = 7 Time Units
Total Units x Conversion Factor = Maximum Allowable Fee
Total Base Units = 6 + Total Time = 7 = Total units = 11
Times $37.02 = $ Maximum Allowed fee
Chapter 6

34. Applying the Concepts Step 5: Calculate anesthesia time
 Time not given; however, if procedure performed was 60 minutes, time calculation would be
10-minute increments – 6 time units
15-minute increments – 4 time units
+ Relative value units = Total units
Chapter 6

35. Coding Procedures & Services Calculating Anesthesia Time/ Example
Anesthesia for arthroscopic procedure of knee joint.
Conversion Unit = $ 49.95
Basic Value = 3
Time Units = 8
Modifier = 0
What is the procedure cold?
What is the Anesthesia Fee?
Procedure Code:
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Anesthesia Fee: $549.45
Anesthesia Fee = $ (49.95 x 3)+(49.95 x 8)+(49.95 x 0)= $ Formula: AF=(BUxCF)+(CFxTU)+(CF xM) or AF = (BU+TU+M) x (CF)
Chapter 6

36. Coding Procedures & Services Anesthesia Section (00100-01999, 99100-99140) PERFORMANCE EXERCISE
Breast Reconstrution, normal healthy patient
00402 & Modifier P1
Anesthesia for open procedures involving upper 2/3 of femur, not otherwise specified
01230
Anesthesia for procedures on facial bones or skull; not otherwise specified
00190
Chapter 6

37. Billing Instructions CMS-1500 Submission
Coding Procedures & Services Anesthesia Section/ Section/Billing Instructions ( , )
Billing Instructions
CMS-1500 Submission
Item 24D – the appropriate anesthesia modifier. Must be reported.
Item 24G – the actual anesthesia time, in minutes, must be reported.
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Chapter 6

38. Anesthesia Salaries: Salaried CRNA = 180,000* Salaried MD = 300,000
Potential Profits with Salaried CRNA’s
Chapter 6

39. CRNA Recruitment Offers Mar 9th, 2005 Robert Kelsey & Associates www
CRNA Recruitment Offers Mar 9th, 2005 Robert Kelsey & Associates
ARKANSAS
Call 1 in 5
$170,000
7 wks. vacation
GEORGIA
Call 6 per month
$200,000 ?
ILLINOIS
Chapter 6

40. Educational Differences
CRNA
4 yrs. College
(1/3 practicing anesthetist w/undergraduate degree)
> 1 yr nursing experience
2-3 yrs nurse anesthetist training MD
4 yrs. College
4 yrs. Medical school
4 yrs. Residency
Fellowship?
Chapter 6

41. Certification DifferencesMD
Written test
Oral exam
Subspecialty exams
CRNA
Written test
MD vs CRNA Recertification Differences
CRNA
2 yr recertification MD
10 yr recertification
(Jan 2000)
Chapter 6