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Chapter 61 Anesthesia Part II: CODING PROCEDURES Part II:

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Presentation on theme: "Chapter 61 Anesthesia Part II: CODING PROCEDURES Part II:"— Presentation transcript:

1 Chapter 61 Anesthesia Part II: CODING PROCEDURES Part II:

2 Chapter 62 injection inhalationmuscular relaxation, loss of sensation and/or loss of consciousness. 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. Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

3 Chapter 63 Types & Anesthesia Classification/Types &Examples: Gel applied to the urethra for dilation Topical/Gel applied to the urethra for dilation Included Included in surgical procedure (can not bill separately) Subcutaneous injection to remove a nerve Local/ Subcutaneous injection to remove a nerve Included Included in surgical procedure (can not bill separately) Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

4 Chapter 64 Types & Examples: Cont. Anesthesia Classification/Types & Examples: Cont. Epidural delivery injection used during labor & delivery Regional/Epidural delivery injection used during labor & delivery Not Not Included in surgical procedure (can bill separately) Inhalation of a substance during tonsillectomy to render the patient totally unconscious General/Inhalation of a substance during tonsillectomy to render the patient totally unconscious Not Not Included in surgical procedure (can bill separately) Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

5 Chapter 65 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. Radiological Procedures - subsection is used when anesthesia is provided during a diagnostic or therapeutic radiologic service. Burn Excisions Other Procedures - The Burn section 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. Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

6 Chapter 66 Research Anesthesia Codes by: Where Where - surgery was performed (anatomic site) What - What - type of anesthesia administered Who - Who - provided the anesthesia (anesthesiologist, physician, etc) Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

7 Chapter 67 Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )  To Find Anesthesia Code:  Bunionectomy  Index/Anesthesia/Foot (anatomic part)

8 Chapter 68 Anesthesia Modifiers Anesthesia Modifiers must be used with anesthesia procedure codes to indicate whether the procedure was: Personally performed, Personally performed, Medical directed Medical directed or Medically supervised. Medically supervised. Anesthesia Section/Modifiers ( , ) Coding Procedures & Services Anesthesia Section/Modifiers ( , )

9 Chapter 69 AA - AA - Anesthesia services personally performed by anesthesiologist. AD AD – Medical supervised by a physician QK QK – Medical direction of two, to four concurrent anesthesia procedures involving qualified individuals QS QS – Monitored anesthesia care QX QX – CRNA service (Certified Registered Nurse Anesthetist) QY QY – Medical direction of one CRNA by a physician QZ QZ – CRNA service; without medical direction by a physician Anesthesia Section/Modifiers ( , ) Coding Procedures & Services Anesthesia Section/Modifiers ( , )

10 Chapter 610 Physical Status The Physical Status is the condition of the patient at the time anesthesia was administered. Anesthesiologistphysical status An Anesthesiologist determines the physical status of a patient & document the information in the Anesthesia record. Physical Status Modifier The Physical Status Modifier are located in the Anesthesia Guidelines. Anesthesia Section/Physical Status Modifiers ( , ) Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )

11 Chapter 611 Modifiers (anesthesia by surgeon) P1-P6 P1-P6 (Physical Status Modifiers) P1 P1 A normal healthy patient P2 P2 A patient with mild systemic disease P3 P3 A patient with severe systemic disease P4 P4 A patient with severe systemic disease that is a constant threat to life P5 P5 A moribund patient who is not expected to survive without the operation P6 P6 A declared brain-dead patient whose organs are being removed for donor purposes. Anesthesia Section/Physical Status Modifiers ( , ) Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )

12 Chapter 612 (American Society of Anesthesiologists ) (American Society of Anesthesiologists ) ASA (American Society of Anesthesiologists ) allows other medical modifiers to be used in anesthesia which include: (American Society of Anesthesiologists ) -22 – unusual services; -23 – unusual anesthesia; by the same physician on the same day of the procedure or other service; -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. Anesthesia Section/Physical Status Modifiers ( , ) Coding Procedures & Services Anesthesia Section/Physical Status Modifiers ( , )

13 Chapter 613 Qualifying Circumstances ( )/Medicine Section ( )/Medicine Section Located in the Anesthesia Guidelines Identified by + symbol as an “add-on-code”. Anesthesia Section/ Section/Qualifying Circumstances ( , ) Coding Procedures & Services Anesthesia Section/ Section/Qualifying Circumstances ( , )

14 Chapter 614 Anesthesia Section/Billing Information ( , ) Coding Procedures & Services Anesthesia Section/Billing Information ( , )  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), Fee/Payment procedure service "Basic Unit Value" Conversion Factor  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.

15 Chapter 615 Basic Unit Value American Society of Anesthesiologists (ASA). Is the basis for determining the base points is the Relative Value Guide published by the American Society of Anesthesiologists (ASA). Anesthesia Payment & Billing Information Anesthesia Payment & Billing Information

16 Chapter 616 Billing Information Anesthesia Payment & Billing Information Time Units  Time Units  Time Units will be determined by using the total time in minutes actually spent performing the procedure.  Fifteen Minutes  Fifteen Minutes is equivalent to one (1) time unit.  Time Units (i.e., 49/15=3.26 or 3.3)  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)

17 Chapter 617 Anesthesia Payment & Billing Information Anesthesia Payment & Billing Information Unit Value(s) Anesthesiologists CRNAs Physical Status Modifiers – to be billed by Anesthesiologists and/or CRNAs P1 A normal healthy person 0 P2 A patient with mild systemic disease 0 P3 A patient with severe systemic disease 1 P4 A patient with severe systemic disease that is a constant threat to life 2 P5 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 0

18 Chapter 618 Anesthesia Payment & Billing Information Unit Value(s) Anesthesiologists CRNAs Qualifying Circumstances to be billed by Anesthesiologists and/or CRNAs Anesthesia for patients of extreme age, under 1 year and over 70 (list separately in addition to code for primary procedure) total body Anesthesia complicated by utilization of total body hypothermia (list separately in addition to code for primary procedure) controlled hypotension Anesthesia complicated by utilization of controlled hypotension (list separately in additional to code for primary procedure) emergency conditions Anesthesia complicated by emergency conditions (specify) (list separately in addition to code for primary procedure) 2

19 Chapter 619 Anesthesia Section Calculating Anesthesia Time ( , 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”.

20 Chapter 620 Anesthesia Section Calculating Anesthesia Time ( , ) 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. "Basic Unit Value"Conversion FactorBase Obtained from the American Society of Anesthesiologists (ASA) 1988 Relative Value Guide  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 FORMULA: (Base Units + Times Units+ Modifying Units) x Conversion Factor = Allowance

21 Chapter 621 Anesthesia Section Calculating Anesthesia Time ( , ) Coding Procedures & Services Anesthesia Section/ Calculating Anesthesia Time ( , )  Anesthesia time is the time during which an anesthesia practitioner is present with the patient. one time unit for each 15 minutes of anesthesia.  Time units are determined on the basis of one time unit for each 15 minutes of anesthesia.  Time Units  Round-up  Round-up if five or more  Round-down  Round-down if four or less Calculating Anesthesia Time

22 Chapter 622 Example A (Round-down): Example A (Round-down): 95 minutes/15 = 6.3. Total anesthesia time = 95 minutes/15 = /3 = /3 = Total time units claimed = 6 Example B (Round-up): Example B (Round-up): 70 minutes/15 = 4.6. Total anesthesia time = 70 minutes/15 = /15 = /15 = Total time units claimed = 5 Anesthesia Section Calculating Anesthesia Time ( , ) Coding Procedures & Services Anesthesia Section/ Calculating Anesthesia Time ( , )

23 Chapter 623 CALCULATION EXAMPLES: CALCULATION EXAMPLES: EXAMPLE 1: Basic Unit Value of 3.0 requiring one hour and forty-five minutes of anesthesia time, 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: Anesthesia Section Calculating Anesthesia Time ( , ) Coding Procedures & Services Anesthesia Section/ Calculating Anesthesia Time ( , ) Basic Unit Value = 3.0 units (ASA) 105 minutes÷15 minutes = 7.0 units (60+45=105) Total value = 10.0 units   Total Units * Conversion Factor = Maximum Allowable Fee Example 1*$48.75conversion factor Example 1 – 10 Total Units * $48.75 (conversion factor) = $ (max fee)

24 Chapter 624 Anesthesia Section ( , ) Coding Procedures & Services Anesthesia Section ( , )

25 Chapter 625 EXAMPLE 2: Basic Unit Value10.0 requiring four hours and twenty minutes of anesthesia timeEXAMPLE 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 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 Calculating Anesthesia Time   Total Units * Conversion Factor = Maximum Allowable Fee Example 2 - *$48.75conversion factor) 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)

26 Chapter 626 Calculating Anesthesia Time Maximum Allowable Fee multiplying the Total Value Units by the Conversion Factor. In both examples, the Maximum Allowable Fee is determined by multiplying the Total Value Units by the Conversion Factor. The Basic Unit Value and Time Units separately 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

27 Chapter 627 Calculating Anesthesia Time Procedure code + Modifier(s) = Basic Unit Value Procedure CodeBasic Unit Value TM Anesthesia Time = Time Units 1 Hour 30 minutes = 6 Time Units Total value = Total units Basic Units = Time units = 11 Total Units Maximum Allowable Fee Total Units x Conversion Factor = Maximum Allowable Fee Total Units = 11 x $48.70 = Conversion Factor = $ Max allowed Procedure code + Modifier(s) = Basic Unit Value Anesthesia Time = Time Units Total value = Total units

28 Chapter 628 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

29 Chapter 629 Applying the Concepts   Identify the needed components for assigning anesthesia codes and appropriate modifiers in the procedure below:   Cornea Transplant

30 Chapter 630 Applying the Concepts Step 1: procedure/service Step 1: Identify anesthesia procedure/service  Corneal transplant Head  Subsection: Head eye  Anesthesia procedures on eye: Corneal transplant Code: 00144

31 Chapter 631 Applying the Concepts physical status Step 2: Assign physical status modifier  No medical conditions listed, therefore P1 Physical status modifier = P1 Normal healthy patient with no risks qualifying circumstance Step 3: Assign qualifying circumstance, if applicable  No qualifying circumstances identified; therefore, none assigned

32 Chapter 632 Applying the Concepts modifier codes, Step 4: Assign modifier codes, if applicable  No extenuating circumstances identified that require assignment of a modifier code

33 Chapter 633 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 Hr. 30 (90 min) 90/15 = 6 / (Base unit only) 7 Time Units Anesthesia’s time = 1hr 45 min = 7 Time Units Maximum Allowable Fee Total Units x Conversion Factor = Maximum Allowable Fee Total Base Units = 6Total Time = 7Total units = 11 Total Base Units = 6 + Total Time = 7 = Total units = 11 Times $37.02 = $ Maximum Allowed fee

34 Chapter 634 Applying the Concepts Step 5: Calculate anesthesia time  60 minutes,  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

35 Chapter 635 Anesthesia for arthroscopic procedure of knee joint. Conversion Unit = $ Basic Value = 3 Time Units = 8 Modifier = 0 1.What is the procedure cold? 2.What is the Anesthesia Fee? Calculating Anesthesia Time/ Example Coding Procedures & Services Calculating Anesthesia Time/ Example Procedure Code: Anesthesia Fee: Anesthesia Fee: $ Formula:AF=(BUxCF)+(CFxTU)+(CF xM) or AF = (BU+TU+M) x (CF) 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)

36 Chapter 636 Anesthesia Section ( , ) PERFORMANCE EXERCISE Coding Procedures & Services Anesthesia Section ( , ) PERFORMANCE EXERCISE Anesthesia for open procedures involving upper 2/3 of femur, not otherwise specified Anesthesia for procedures on facial bones or skull; not otherwise specified Breast Reconstrution, normal healthy patient & Modifier P1

37 Chapter 637 Billing Instructions CMS-1500 Submission CMS-1500 Submission Item 24D – the appropriate anesthesia modifier. Must be reported. Item 24G – the actual anesthesia time, in minutes, must be reported. Anesthesia Section/ Section/Billing Instructions ( , ) Coding Procedures & Services Anesthesia Section/ Section/Billing Instructions ( , )

38 Chapter 638 Anesthesia Salaries: Salaried CRNA = 180,000 * Salaried MD = 300,000 Potential Profits with Salaried CRNA’s

39 Chapter 639 CRNA Recruitment Offers Mar 9th, 2005 Robert Kelsey & Associates ARKANSAS Call 1 in 5 $170,0007 wks. vacation GEORGIACall 6 per month $200,000 ? ILLINOISCall 1 in 5$200,000 ?

40 Chapter 640 Educational Differences MD 4 yrs. College 4 yrs. Medical school 4 yrs. Residency Fellowship? CRNA 4 yrs. College (1/3 practicing anesthetist w/undergraduate degree) > 1 yr nursing experience 2-3 yrs nurse anesthetist training

41 Chapter 641 Certification Differences MD Written test Oral exam Subspecialty exams CRNA Written test MD vs CRNA Recertification Differences MD 10 yr recertification (Jan 2000) CRNA 2 yr recertification


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