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CODING PROCEDURES Part II:

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Presentation on theme: "CODING PROCEDURES Part II:"— Presentation transcript:

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. Page 134 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 Page 134 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 Page 134 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. Page 134 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) Page 134 Chapter 6

7 Index/Anesthesia/Foot (anatomic part)
Coding Procedures & Services Anesthesia Section ( , ) To Find Anesthesia Code: Bunionectomy Index/Anesthesia/Foot (anatomic part) Page 135 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. Page 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 Page 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. Page 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. Page 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. Page 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”. Page 135 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. Page 135 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”. Page 135 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 Page 135 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 Page 135 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 Page 135 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 Page 135 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)
Page 135 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: Page 135 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. Page 135 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 Differences
MD 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


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