The Complete Procedure Coding Book By Shelley C The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 6 Anesthesia Coding McGraw Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes 6 - 2 Correctly apply the guidelines for proper anesthesia coding. Interpret the types of anesthesia as they relate to the coding process. Select the best, most appropriate code for anesthesia services.

Learning Outcomes 6 - 3 Abstract the notes to determine the correct physical status modifier. Correctly apply qualifying circumstances add-on codes. Properly use HCPCS Level II modifiers.

Introduction 6 - 4 The procedure codes for reporting the administration of anesthetics are in the second section of CPT. Codes 00100-01999 and codes 99100 - 99140 from the medicine section

Types of Anesthesia Topical and/or Local Regional General 6 - 5 Topical and/or Local Regional General Moderate (conscious) sedation Monitored Anesthesia Care (MAC)

Coding Anesthesia Confirm who administered the anesthetic. 6 - 6 Confirm who administered the anesthetic. Physician also doing the procedure Another physician Identify anatomical site upon which the procedure is being performed that requires the patient to be anesthetized.

Coding Anesthesia 6 - 7 Confirm the exact procedure performed, as documented in the physician’s notes. Consult the CPT book - alphabetic index. Go to the numeric portion of CPT to confirm the code.

Coding Anesthesia 6 - 8 When the same physician performing the procedure is the one administering regional or general anesthesia, DO NOT use a code from the anesthesia section. Use modifier 47 Anesthesia by Surgeon, which is appended to the code for that procedure.

Coding Anesthesia 6 - 9 Surgical procedure codes already include topical, local, and digital block anesthesia. Do not code these separately from the anesthesia section. Moderate (conscious) sedation is coded from the Medicine section.

Anesthesia Guidelines 6 - 10 Anesthesia codes already include: Usual pre-operative visits. Anesthesia care during the procedure. Administration of fluids. Usual monitoring services. Usual post-operative visits.

Anesthesia Guidelines 6 - 11 When multiple procedures are performed during the same operative session, the anesthesia should be coded for the most complicated procedure only.

Time Reporting 6 - 12 Clock starts when the anesthesiologist start to prepare the patient for administration of anesthetic Measured in 15-minute increments Clock stops when patient is in post-operative area

Time Reporting (B + T +M) * CF 6 - 13 (B + T +M) * 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

Qualifying Circumstances 6 - 14 99100 Patient of extreme age 99116 Total body hypothermia 99135 Controlled hypotension 99140 Emergency conditions

Conscious Sedation Also called Moderate Sedation 6 - 15 Also called Moderate Sedation Administered by same physician performing the procedure, use codes 99143 - 99145

Conscious Sedation 6 - 16 Administered by another physician, use codes 99148 - 99150 unless…Location is physician’s office or freestanding imaging center, conscious sedation is not separately reported

Conscious Sedation Administered by another physician 6 - 17 Administered by another physician And the procedure is NOT LISTED in Appendix G Code conscious sedation from the anesthesia section 00100 - 01999

Conscious Sedation 6 - 18 Procedure codes listed in Appendix G have a bull’s eye symbol  next to the code in the numeric listing These codes include conscious sedation - do not code it separately

Anesthesia Modifiers 23 Unusual Anesthesia 47 Anesthesia by Surgeon 6 - 19 23 Unusual Anesthesia 47 Anesthesia by Surgeon Do NOT append to an anesthesia code but to the code for the procedure

Anesthesia Modifiers Physical Status Modifiers 6 - 20 Physical Status Modifiers 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

Anesthesia Modifiers Physical Status Modifiers 6 - 21 Physical Status Modifiers Appended to ALL anesthesia codes NEVER appended to any other types of codes

Anesthesia Modifiers AA Anesthesiologist 6 - 22 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

Anesthesia Modifiers 6 - 23 HCPCS Level II Modifiers QK Medical direction of 2, 3, or 4 concurrent procedures QS MAC QY Medical direction of CRNA QX CRNA service under supervision QZ CRNA service without supervision

Chapter Summary 6 - 24 Code for reporting services to patients in need of an anesthetic, no matter who had administered it or why. These factors are critical to obtaining proper reimbursement.