AAPC Chapter 16: Anesthesia Notes Flashcards
How are anesthesia codes are grouped?
Anatomically (beginning with the head).
In addition to anatomic sections, what other sections are included in the Anesthesia section (4)?
Radiological Procedures, Burn Excisions or Debridement, Obstetric, Other Procedures
When codes are not found under the surgical description, how should the medical coder search for an anesthesia code?
By anatomic location (e.g., a simple mastectomy is listed under Anesthesia/Breast, not Anesthesia/ Mastectomy)
What is the default code to report unlisted anesthesia services?
01999 Unlisted anesthesia procedure(s).
What are the three different types of anesthesia?
General, regional, monitored anesthesia care (MAC).
Type of anesthesia with drug-induced loss of consciousness.
General anesthesia.
Type of anesthesia with a loss of sensation in a region of the body.
Regional anesthesia.
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.
Spinal anesthesia.
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.
Epidural anesthesia.
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).
Nerve block anesthesia.
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.
Monitored anesthesia care (MAC).
Type of anesthesia that is monitored by an anesthesia provider who is prepared to convert to general anesthesia, if necessary.
Monitored anesthesia care (MAC).
A physician who has completed an accredited anesthesiology program.
Anesthesiologist.
These physicians personally perform, medically direct, or medically supervise members of an anesthesia care team.
Anesthesiologist.
An advanced practice registered nurse (APRN) who has completed an accredited nurse anesthetist training program.
Certified registered nurse anesthetist (CRNA).
May be medically or non-medically directed by an anesthesiologist.
Certified registered nurse anesthetist (CRNA).
Has a premedical background, a baccalaureate degree, and a master’s degree from an accredited anesthesia assistant training program.
Certified anesthesiologist assistant (CAA).
May only be medically directed by an anesthesiologist.
Certified anesthesiologist assistant (CAA).
A physician who has completed his medical degree and is in a residency program specifically for anesthesiology training.
Anesthesia resident.
Occurs when one lung is ventilated and the other is collapsed temporarily to improve surgical access to the lung or thoracic cavity.
One-Lung Ventilation (OLV).
Term used when a cardiopulmonary bypass (CPB) machine is used to function as the heart and lungs during heart surgery.
Pump oxygenator.
When a CPB machine is used, what should the anesthesia record should describe?
When the patient went on and off pump.
When a pump oxygenator is not used during heart surgery, what is the surgeon is operating on?
A beating heart.
Term that describes organs within the peritoneal cavity (upper or lower abdominal cavity).
Intraperitoneal.
Intraperitoneal organs in the upper abdomen include…
Stomach, liver, gallbladder, spleen, jejunum, ascending and transverse colon.
Intraperitoneal organs in the lower abdomen include…
Appendix, cecum, ileum, sigmoid colon.
Describes the anatomical space in the abdominal cavity behind or outside the peritoneum (upper or lower abdomen).
Extraperitoneal or retroperitoneal.
Extraperitoneal organs of the upper abdomen include…
Kidneys, adrenal glands, lower esophagus.
Extraperitoneal organs of the lower abdomen include…
Ureters, urinary bladder.
Organs in the retroperitoneum include…
Aorta, inferior vena cava.
Surgery that is usually extensive, complex, and intended to correct a severe health threat such as a rapidly growing cancer.
Radical surgery.
Example of a radical surgery?
Radical hysterectomy: involves removal of the uterus, cervix, upper part of the vagina, and tissues supporting the uterus and lymph nodes.
Arthroscopic procedures may be performed on which joints?
Temporomandibular (TMJ), shoulder, elbow, wrist, hip, knee, ankle.
For arthroscopic surgeries, do you assign a diagnostic code when a surgical procedure is performed?
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).
Who is typically responsible for postoperative pain management?
The surgeon: payment is bundled into the surgeon’s global fee.
When can postoperative pain management be requested by the surgeon and billed separately by an anesthesiologist?
When anesthesia for the surgical procedure is not dependent on efficacy of the regional anesthetic technique.
Postoperative pain management coding depends on which three components?
Material injected, site of the injection and placement of either a single injection block or a continuous block by catheter (infusion).
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.
Modifier 59 Distinct Procedural Services.
Are surgery and radiology codes reported with time units?
No, they are flat-fee and no time is reported separately; only anesthesia codes are reported with time units.
Are codes reported separately for ultrasound or fluoroscopic guidance utilized for pain management procedures?
Yes, unless the code includes imaging guidance (fluoroscopy or CT).
Which modifier is used for codes reported separately for ultrasound or fluoroscopic guidance utilized for pain management procedures?
Modifier 26 Professional Component.
When may nerve block codes be used as an adjunct to general anesthesia?
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.
How are continuous infusion catheter codes reported?
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).
When can anesthesiologists report an E/M service to re-evaluate postoperative pain?
When documentation supports the necessity.
How many cervical vertebrae in the spinal column?
7 cervical vertebrae.
How many thoracic vertebrae in the spinal column?
12 thoracic vertebrae.
How many lumbar vertebrae in the spinal column?
5 lumbar vertebrae.
How many sacral vertebrae in the spinal column?
5 sacral vertebrae (fused together to form the sacrum).
Which vertebrae support the ribs?
T1 through T10.
When is epidural reported?
When anesthesia is injected into the epidural space of the spine, including the cervical, thoracic or lumbar area.
When is subarachnoid or spinal anesthesia reported?
When anesthesia, opioids, or steroids are injected into the subarachnoid or CSF space.
When an epidural or subarachnoid catheter is placed for a laboring patient, are injection codes typically reported?
No.
Where are codes for labor epidural/ subarachnoid services listed?
In the Obstetric section of anesthesia codes.
When is daily hospital management of continuous epidural or subarachnoid drug administration (01996) reported?
Starting on the first postoperative day (not on the day of epidural or subarachnoid catheter placement).
Are the diagnoses listed on the pre-anesthesia assessment routinely reported?
No.
When are diagnosis codes to report the history of a condition reported?
Only when the history is relevant to the current condition.
Does the medial coder code the preoperative diagnosis or postoperative diagnosis?
The postoperative diagnosis, because the preoperative diagnosis may change intraoperatively.
Is routine postoperative pain coded?
No.
When the provider is treating non-routine postoperative pain, select a code from which category?
Category G89, based on whether the pain is documented as acute or chronic.
For Category G89, when pain is not stated as acute or chronic, how is it coded?
Code to acute.
When the underlying condition causing the pain is treated, which is coded first: the underlying condition or the code for pain (Category G89)?
List the condition first and, if appropriate, report a second code from G89 (see ICD-10-CM guideline I.C.6.b).
Example: A patient has surgery for a herniated disc causing chronic back pain.
Code for a herniated disc but not the chronic back pain.
Example: anesthesia provider places an epidural for acute postoperative back pain.
Report the diagnosis code for a herniated disc (M51.9) and acute postoperative pain (G89.18).
Are unusual forms of monitoring (e.g., arterial lines, central venous catheters, and pulmonary artery catheters (eg, Swan-Ganz)) included in the anesthesia code?
No, they are not included and may be separately reported.
Each anesthesia code has what type of value assigned?
A base unit value, BUV (not listed separately in the CPT®).
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?
The American Society of Anesthesiologists (ASA).
How are BUVs determined?
By difficulty of the procedure performed.
Two initial steps in calculating anesthesia charges?
Determining the BUV, time reporting.
When does anesthesia time begin?
When the anesthesiologist begins to prepare the patient for anesthesia in either the operating room or an equivalent area.
Is the pre-anesthesia assessment time part of reportable anesthesia? Why or why not?
No, because it is considered in the base value assigned.
When does anesthesia time end?
When the anesthesiologist is no longer in personal attendance (generally when patient is safely transferred to PACU or equivalent unit).
Does anesthesia time need to be continuous?
No.
Is there national guidance regarding time reporting on claims?
No: time reporting on claims may vary between local areas (there is no national guidance).
Does medicare round anesthesiology time to the nearest 5 minutes?
No, Medicare requires exact time reporting without rounding to the nearest five minutes.
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)?
$215.80 (9.8 x $22.02 = $215.80).
9.8 = 6 base value units and 3.8 time units (57/15).
Why should anesthesia coders validate insurance carrier time increments prior to billing a claim?
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).
Example: Anesthesia time = 120 minutes, 2022 national conversion factor: $21.5623. What would be the total Medicare payment? Commercial insurance payment (10 minute increments)?
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.
What is reported when multiple surgical procedures are performed on one patient during anesthesia administration?
The surgery representing the most complex procedure, because this service carries a higher BUV (anesthesia time is reported as usual).
When multiple surgical procedures are performed on one patient during anesthesia administration, is Modifier 51 (Multiple Procedures) used?
No, because only procedure is reported.
Only one anesthesia code is reported during anesthesia administration… with what exception?
In the case where there is an anesthesia add-on code.
When multiple surgical procedures are performed on one patient during anesthesia administration, how is time reported?
Total time for all procedures is reported as anesthesia time.
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?
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.
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.
Qualifying Circumstance (QC) codes.
Can more than one QC code be listed?
Yes, when applicable, unless the reported CPT® code already contains the risk factor (indicated with a parenthetical reference).
What kinds of codes are QC codes?
Add-on codes: they cannot be reported without an associated anesthesia procedure code.
Are QC codes recognized by Medicare for additional payment?
No.
Do QC codes have base values listed in CPT®?
No.
Who assigns BUVs for the qualifying circumstances.
The American Society of Anesthesiologists (ASA).
QC code: Anesthesia for patient of extreme age, younger than 1 year and older than 70.
+99100.
+99100: how many extra units?
1 extra unit.
QC code: Anesthesia complicated by utilization of total body hypothermia.
+99116.
+99116: how many extra units?
5 extra units.
QC code: Anesthesia complicated by utilization of controlled hypotension.
+99135.
+99135: how many extra units?
5 extra units.
QC code: Anesthesia complicated by emergency conditions (specify).
+99140.
+99140: how many extra units?
2 extra units.
Emergency conditions do not apply to which situations?
After normal-hour care or routine obstetric labor.
To review: calculation of anesthesia services for for Medicare.
(BASE + TIME) X Medicare conversion factor for the region.
To review: calculation of anesthesia services for for non-Medicare.
(BASE + TIME + PHYSICAL STATUS MODIFERS + QUALIFYING CIRCUMSTANCES) X conversion factor for non-Medicare payers.
