1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 6-1 Chapter 6 Anesthesia Coding

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives 6.1 Interpret the types of anesthesia as they relate to the coding process. 6.2 Correctly apply the guidelines for proper anesthesia coding. 6.3 Apply the formula for using time to report anesthesia services. 6-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) 6.4 Correctly use qualifying circumstances add-on codes. 6.5 Properly report the administration of moderate (conscious) sedation. 6.6 Abstract the notes to determine the correct physical status modifiers. 6-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Anesthesia Anesthesiologists Certified registered nurse anesthetist (CRNA) Conscious sedation 6-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) General anesthesia Local anesthesia Monitored anesthesia care (MAC) Regional anesthesia Topical anesthesia 6-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Administration of Anesthesia Anesthesiology codes range from: –00100 to 01999 –99100 to 99140 Anesthesiologists –Work in hospital or an ambulatory surgical center settings. –Are not employees of the hospital. –Must submit their own claims independent of the hospital. 6-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Types of Anesthesia Suppression of nerve sensations to relieve or prevent the feeling of pain –Topical anesthesia Numbs surface nerves. –Local anesthesia Dulls feeling in a limited area of the body. 6-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Types of Anesthesia (cont.) Regional anesthesia –Prevents a section of the body from transmitting pain. General anesthesia –Also known as surgical anesthesia. –Total loss of consciousness and sensation. 6-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Types of Anesthesia (cont.) Conscious sedation –Anti-anxiety medication –Anesthesiologist not required Monitored anesthesia care (MAC) –An anesthesiologist is present during administration of conscious sedation. 6-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Anesthesia Services Confirm –That the physician who performed the procedure is different from the physician administering anesthesia. –If the same physician does both: A code from the anesthesia section is not used. Modifier 47 is appended to the procedure code. 6-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Anesthesia Services (cont.) Identify the anatomical site that is the focus on the procedure. Confirm the exact surgical procedure performed, as documented in the surgeon’s notes. 6-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Anesthesia Services (cont.) Consult the alphabetic index of the CPT book: –Find Anesthesia –Locate the anatomical site beneath Identify the suggested code or codes for this site. 6-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Coding Anesthesia Services (cont.) Find the codes suggested by the Index in the numerical portion of the CPT book. Read the descriptions next to each and every code suggested. Compare them with the terms used by the physician in his or her notes. 6-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Anesthesia Guidelines Anesthesia codes include –Usual preoperative visits –Anesthesia care during the procedure –Administration of fluids –Usual monitoring services ECG (electrocardiogram) –Usual postoperative supervision in recovery 6-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Anesthesia Guidelines (cont.) When multiple procedures are performed during the same operative session, the anesthesia should be coded for the most complicated procedure only. 6-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Time Reporting Clock starts when the anesthesiologist starts to prepare the patient for administration of anesthetic. Measured in 15-minute increments. Clock stops when patient is in postoperative area (recovery). 6-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Time Reporting (cont.) (B + T + M) x CF –B = base unit (assigned by the American Society of Anesthesiologists) –T = time spent –M = modifying factor –CF = conversion factor to turn units into dollars 6-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Qualifying Circumstances Cause the administration of anesthesia to be more complicated. Add-on code explains: –99100 Patient of extreme age (under 1 year or over 70 years) –99116 Total body hypothermia –99135 Controlled hypotension –99140 Emergency conditions 6-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Moderate (Conscious) Sedation Codes 99143–99150 report the administration of moderate sedation, which includes –Assessing the patient –Establishing IV access and fluids to maintain patency, when performed –Administration of the drug –Maintaining the sedated level –Monitoring oxygen saturation, heart rate, and blood pressure –Observation and assessment during recovery 6-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Moderate (Conscious) Sedation (cont.) Guidelines –If physician performs procedure and administration of sedation, use codes from 99143–99145 range. –If separate physician administers sedation, use codes from 99148–99150 range. –If procedure performed is not listed in Appendix G and a second physician administers sedation, use codes from 00100–01999 range. 6-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Moderate (Conscious) Sedation (cont.) Guidelines (cont.) –The CPT codes that include conscious sedation are identified with a circle with a dot in the center  –The clock starts when the physician administers the sedative and the clock stops when the patient is in the postoperative area (recovery). 6-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Unusual Anesthesia Unusual circumstances might require the administration of general anesthesia for a procedure that typically requires either local anesthesia or no anesthesia. Use modifier 23 appended to the procedure code. 6-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Physical Status Modifiers Physical status modifiers are mandatory with every anesthesia code: –P1 Normal healthy patient –P2 Mild systemic disease –P3 Severe systemic disease –P4 Systemic disease is threat to life –P5 Moribund patient –P6 Brain-dead patient 6-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. HCPCS Level II Modifiers AA Anesthesiologist AD Medical supervision of more than 4 concurrent procedures G8 Monitored anesthesia care (MAC) complex procedure G9 MAC for patient with severe cardiopulmonary condition 6-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. HCPCS Level II Modifiers (cont.) QK Medical direction of 2, 3, or 4 concurrent procedures QS MAC (Monitored Anesthesia Care) QY Medical direction of CRNA QX CRNA service under supervision QZ CRNA service without supervision 6-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary For the most part, anesthesia coding is for the purposes of submitting health insurance claim forms on behalf of the anesthesiologist or a member of his or her staff, such as a CRNA. Once you determine the best, most appropriate code for the dispensation of the anesthesia, you also have to append the correct modifiers, when applicable. 6-26