1. 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

2. 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.

3. 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.

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

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

6. 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.

7. Coding Anesthesia
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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.

8. Coding Anesthesia
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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.

9. Coding Anesthesia
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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.

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

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

12. Time Reporting
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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

13. 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

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

15. Conscious Sedation Also called Moderate Sedation
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Also called Moderate Sedation
Administered by same physician performing the procedure, use codes

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

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

18. 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

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

20. Anesthesia Modifiers Physical Status Modifiers
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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

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

22. Anesthesia Modifiers AA Anesthesiologist
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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

23. 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

24. 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.