AAPC Chapter 16: Anesthesia Notes

Question 1

How are anesthesia codes are grouped?

Answer 1

Anatomically (beginning with the head).

Question 2

In addition to anatomic sections, what other sections are included in the Anesthesia section (4)?

Answer 2

Radiological Procedures, Burn Excisions or Debridement, Obstetric, Other Procedures

Question 3

When codes are not found under the surgical description, how should the medical coder search for an anesthesia code?

Answer 3

By anatomic location (e.g., a simple mastectomy is listed under Anesthesia/Breast, not Anesthesia/ Mastectomy)

Question 4

What is the default code to report unlisted anesthesia services?

Answer 4

01999 Unlisted anesthesia procedure(s).

Question 5

What are the three different types of anesthesia?

Answer 5

General, regional, monitored anesthesia care (MAC).

Question 6

Type of anesthesia with drug-induced loss of consciousness.

Answer 6

General anesthesia.

Question 7

Type of anesthesia with a loss of sensation in a region of the body.

Answer 7

Regional anesthesia.

Question 8

Regional anesthesia for surgeries performed below the upper abdomen where an anesthetic agent is injected in the subarachnoid space into CSF in the spinal canal.

Answer 8

Spinal anesthesia.

Question 9

Regional anesthesia where an anesthetic agent is injected in the epidural space; a small catheter may be placed for continuous treatment or to assist with postoperative pain.

Answer 9

Epidural anesthesia.

Question 10

Regional anesthesia where an anesthetic agent is injected directly into the area around a nerve to block sensation in the surgical region (commonly used for procedures on the arms or legs).

Answer 10

Nerve block anesthesia.

Question 11

Type of anesthesia where the patient is under light or no sedation in surgery with local anesthesia provided by the surgeon; patient can respond to purposeful stimulation and maintain an airway.

Answer 11

Monitored anesthesia care (MAC).

Question 12

Type of anesthesia that is monitored by an anesthesia provider who is prepared to convert to general anesthesia, if necessary.

Answer 12

Monitored anesthesia care (MAC).

Question 13

A physician who has completed an accredited anesthesiology program.

Answer 13

Anesthesiologist.

Question 14

These physicians personally perform, medically direct, or medically supervise members of an anesthesia care team.

Answer 14

Anesthesiologist.

Question 15

An advanced practice registered nurse (APRN) who has completed an accredited nurse anesthetist training program.

Answer 15

Certified registered nurse anesthetist (CRNA).

Question 16

May be medically or non-medically directed by an anesthesiologist.

Answer 16

Certified registered nurse anesthetist (CRNA).

Question 17

Has a premedical background, a baccalaureate degree, and a master’s degree from an accredited anesthesia assistant training program.

Answer 17

Certified anesthesiologist assistant (CAA).

Question 18

May only be medically directed by an anesthesiologist.

Answer 18

Certified anesthesiologist assistant (CAA).

Question 19

A physician who has completed his medical degree and is in a residency program specifically for anesthesiology training.

Answer 19

Anesthesia resident.

Question 20

Occurs when one lung is ventilated and the other is collapsed temporarily to improve surgical access to the lung or thoracic cavity.

Answer 20

One-Lung Ventilation (OLV).

Question 21

Term used when a cardiopulmonary bypass (CPB) machine is used to function as the heart and lungs during heart surgery.

Answer 21

Pump oxygenator.

Question 22

When a CPB machine is used, what should the anesthesia record should describe?

Answer 22

When the patient went on and off pump.

Question 23

When a pump oxygenator is not used during heart surgery, what is the surgeon is operating on?

Answer 23

A beating heart.

Question 24

Term that describes organs within the peritoneal cavity (upper or lower abdominal cavity).

Answer 24

Intraperitoneal.

Question 25

Intraperitoneal organs in the upper abdomen include...

Answer 25

Stomach, liver, gallbladder, spleen, jejunum, ascending and transverse colon.

Question 26

Intraperitoneal organs in the lower abdomen include...

Answer 26

Appendix, cecum, ileum, sigmoid colon.

Question 27

Describes the anatomical space in the abdominal cavity behind or outside the peritoneum (upper or lower abdomen).

Answer 27

Extraperitoneal or retroperitoneal.

Question 28

Extraperitoneal organs of the upper abdomen include...

Answer 28

Kidneys, adrenal glands, lower esophagus.

Question 29

Extraperitoneal organs of the lower abdomen include...

Answer 29

Ureters, urinary bladder.

Question 30

Organs in the retroperitoneum include...

Answer 30

Aorta, inferior vena cava.

Question 31

Surgery that is usually extensive, complex, and intended to correct a severe health threat such as a rapidly growing cancer.

Answer 31

Radical surgery.

Question 32

Example of a radical surgery?

Answer 32

Radical hysterectomy: involves removal of the uterus, cervix, upper part of the vagina, and tissues supporting the uterus and lymph nodes.

Question 33

Arthroscopic procedures may be performed on which joints?

Answer 33

Temporomandibular (TMJ), shoulder, elbow, wrist, hip, knee, ankle.

Question 34

For arthroscopic surgeries, do you assign a diagnostic code when a surgical procedure is performed?

Answer 34

No (e.g., if knee arthroscopy is listed as diagnostic and a meniscectomy is performed, a surgical arthroscopic meniscectomy code is assigned without a code for the diagnostic procedure).

Question 35

Who is typically responsible for postoperative pain management?

Answer 35

The surgeon: payment is bundled into the surgeon’s global fee.

Question 36

When can postoperative pain management be requested by the surgeon and billed separately by an anesthesiologist?

Answer 36

When anesthesia for the surgical procedure is not dependent on efficacy of the regional anesthetic technique.

Question 37

Postoperative pain management coding depends on which three components?

Answer 37

Material injected, site of the injection and placement of either a single injection block or a continuous block by catheter (infusion).

Question 38

Post-operative pain management by an anesthesiologist is appended with which modifier to signify that the service is separate and distinct from the anesthesiologist’s care during the surgery.

Answer 38

Modifier 59 Distinct Procedural Services.

Question 39

Are surgery and radiology codes reported with time units?

Answer 39

No, they are flat-fee and no time is reported separately; only anesthesia codes are reported with time units.

Question 40

Are codes reported separately for ultrasound or fluoroscopic guidance utilized for pain management procedures?

Answer 40

Yes, unless the code includes imaging guidance (fluoroscopy or CT).

Question 41

Which modifier is used for codes reported separately for ultrasound or fluoroscopic guidance utilized for pain management procedures?

Answer 41

Modifier 26 Professional Component.

Question 42

When may nerve block codes be used as an adjunct to general anesthesia?

Answer 42

When nerve block placement is for postoperative pain management; they should not be reported separately if the block is the type of anesthesia used during the procedure.

Question 43

How are continuous infusion catheter codes reported?

Answer 43

If placed for operative anesthesia, the appropriate anesthesia code plus time is reported (01996); if placed only for postoperative pain management, daily catheter management is included in 64448 (do not report 01996).

Question 44

When can anesthesiologists report an E/M service to re-evaluate postoperative pain?

Answer 44

When documentation supports the necessity.

Question 45

How many cervical vertebrae in the spinal column?

Answer 45

7 cervical vertebrae.

Question 46

How many thoracic vertebrae in the spinal column?

Answer 46

12 thoracic vertebrae.

Question 47

How many lumbar vertebrae in the spinal column?

Answer 47

5 lumbar vertebrae.

Question 48

How many sacral vertebrae in the spinal column?

Answer 48

5 sacral vertebrae (fused together to form the sacrum).

Question 49

Which vertebrae support the ribs?

Answer 49

T1 through T10.

Question 50

When is epidural reported?

Answer 50

When anesthesia is injected into the epidural space of the spine, including the cervical, thoracic or lumbar area.

Question 51

When is subarachnoid or spinal anesthesia reported?

Answer 51

When anesthesia, opioids, or steroids are injected into the subarachnoid or CSF space.

Question 52

When an epidural or subarachnoid catheter is placed for a laboring patient, are injection codes typically reported?

Answer 52

No.

Question 53

Where are codes for labor epidural/ subarachnoid services listed?

Answer 53

In the Obstetric section of anesthesia codes.

Question 54

When is daily hospital management of continuous epidural or subarachnoid drug administration (01996) reported?

Answer 54

Starting on the first postoperative day (not on the day of epidural or subarachnoid catheter placement).

Question 55

Are the diagnoses listed on the pre-anesthesia assessment routinely reported?

Answer 55

No.

Question 56

When are diagnosis codes to report the history of a condition reported?

Answer 56

Only when the history is relevant to the current condition.

Question 57

Does the medial coder code the preoperative diagnosis or postoperative diagnosis?

Answer 57

The postoperative diagnosis, because the preoperative diagnosis may change intraoperatively.

Question 58

Is routine postoperative pain coded?

Answer 58

No.

Question 59

When the provider is treating non-routine postoperative pain, select a code from which category?

Answer 59

Category G89, based on whether the pain is documented as acute or chronic.

Question 60

For Category G89, when pain is not stated as acute or chronic, how is it coded?

Answer 60

Code to acute.

Question 61

When the underlying condition causing the pain is treated, which is coded first: the underlying condition or the code for pain (Category G89)?

Answer 61

List the condition first and, if appropriate, report a second code from G89 (see ICD-10-CM guideline I.C.6.b).

Question 62

Example: A patient has surgery for a herniated disc causing chronic back pain.

Answer 62

Code for a herniated disc but not the chronic back pain.

Question 63

Example: anesthesia provider places an epidural for acute postoperative back pain.

Answer 63

Report the diagnosis code for a herniated disc (M51.9) and acute postoperative pain (G89.18).

Question 64

Are unusual forms of monitoring (e.g., arterial lines, central venous catheters, and pulmonary artery catheters (eg, Swan-Ganz)) included in the anesthesia code?

Answer 64

No, they are not included and may be separately reported.

Question 65

Each anesthesia code has what type of value assigned?

Answer 65

A base unit value, BUV (not listed separately in the CPT®).

Question 66

Which organization determines base unit values for anesthesia codes and publishes a Relative Value Guide® including the base unit values assigned to each anesthesia code?

Answer 66

The American Society of Anesthesiologists (ASA).

Question 67

How are BUVs determined?

Answer 67

By difficulty of the procedure performed.

Question 68

Two initial steps in calculating anesthesia charges?

Answer 68

Determining the BUV, time reporting.

Question 69

When does anesthesia time begin?

Answer 69

When the anesthesiologist begins to prepare the patient for anesthesia in either the operating room or an equivalent area.

Question 70

Is the pre-anesthesia assessment time part of reportable anesthesia? Why or why not?

Answer 70

No, because it is considered in the base value assigned.

Question 71

When does anesthesia time end?

Answer 71

When the anesthesiologist is no longer in personal attendance (generally when patient is safely transferred to PACU or equivalent unit).

Question 72

Does anesthesia time need to be continuous?

Answer 72

No.

Question 73

Is there national guidance regarding time reporting on claims?

Answer 73

No: time reporting on claims may vary between local areas (there is no national guidance).

Question 74

Does medicare round anesthesiology time to the nearest 5 minutes?

Answer 74

No, Medicare requires exact time reporting without rounding to the nearest five minutes.

Question 75

For Medicare: if the reported anesthesia time is 57 minutes and the procedure has a base value of 6 units, what would the total Medicare payment equal in Bakersfield, California (anesthesia conversion factor of $22.02)?

Answer 75

$215.80 (9.8 x $22.02 = $215.80). 9.8 = 6 base value units and 3.8 time units (57/15).

Question 76

Why should anesthesia coders validate insurance carrier time increments prior to billing a claim?

Answer 76

Because other insurance companies may process anesthesia time in different increments varying from exact time (like Medicare), to 10, 12, or 15 minutes (or other increments).

Question 77

Example: Anesthesia time = 120 minutes, 2022 national conversion factor: $21.5623. What would be the total Medicare payment? Commercial insurance payment (10 minute increments)?

Answer 77

Medicare: Base Value 3, Time (120 min/15) 8, Total units 11 x $21.5623 = $237.19. Commercial Insurance: Base Value 3, Time (120 min/10) 12, Total units 15 x $21.5623 = $323.43.

Question 78

What is reported when multiple surgical procedures are performed on one patient during anesthesia administration?

Answer 78

The surgery representing the most complex procedure, because this service carries a higher BUV (anesthesia time is reported as usual).

Question 79

When multiple surgical procedures are performed on one patient during anesthesia administration, is Modifier 51 (Multiple Procedures) used?

Answer 79

No, because only procedure is reported.

Question 80

Only one anesthesia code is reported during anesthesia administration... with what exception?

Answer 80

In the case where there is an anesthesia add-on code.

Question 81

When multiple surgical procedures are performed on one patient during anesthesia administration, how is time reported?

Answer 81

Total time for all procedures is reported as anesthesia time.

Question 82

A patient has two surgical procedures during one operative session: inguinal herniorrhaphy (00830, 4 base units) and ventral herniorrhaphy (00832, 6 base units). Which procedure(s) are reported?

Answer 82

Only the ventral herniorrhaphy (00832) is reported because it is more complex and has a higher base value. But remember: both diagnosis codes are still reported! May help to explain why the reported anesthesia time is longer than normally expected for the procedure reported.

Question 83

Anesthesia add-on codes used to report anesthesia services performed under difficult circumstances that have a significant effect on the character of an anesthesia service.

Answer 83

Qualifying Circumstance (QC) codes.

Question 84

Can more than one QC code be listed?

Answer 84

Yes, when applicable, unless the reported CPT® code already contains the risk factor (indicated with a parenthetical reference).

Question 85

What kinds of codes are QC codes?

Answer 85

Add-on codes: they cannot be reported without an associated anesthesia procedure code.

Question 86

Are QC codes recognized by Medicare for additional payment?

Answer 86

No.

Question 87

Do QC codes have base values listed in CPT®?

Answer 87

No.

Question 88

Who assigns BUVs for the qualifying circumstances.

Answer 88

The American Society of Anesthesiologists (ASA).

Question 89

QC code: Anesthesia for patient of extreme age, younger than 1 year and older than 70.

Answer 89

+99100.

Question 90

+99100: how many extra units?

Answer 90

1 extra unit.

Question 91

QC code: Anesthesia complicated by utilization of total body hypothermia.

Answer 91

+99116.

Question 92

+99116: how many extra units?

Answer 92

5 extra units.

Question 93

QC code: Anesthesia complicated by utilization of controlled hypotension.

Answer 93

+99135.

Question 94

+99135: how many extra units?

Answer 94

5 extra units.

Question 95

QC code: Anesthesia complicated by emergency conditions (specify).

Answer 95

+99140.

Question 96

+99140: how many extra units?

Answer 96

2 extra units.

Question 97

Emergency conditions do not apply to which situations?

Answer 97

After normal-hour care or routine obstetric labor.

Question 98

To review: calculation of anesthesia services for for Medicare.

Answer 98

(BASE + TIME) X Medicare conversion factor for the region.

Question 99

To review: calculation of anesthesia services for for non-Medicare.

Answer 99

(BASE + TIME + PHYSICAL STATUS MODIFERS + QUALIFYING CIRCUMSTANCES) X conversion factor for non-Medicare payers.