Ch. 16 Anesthesia Flashcards
What modifier is used for medically-directed CRNA services?
c. QX
Response Feedback:
Rationale: In the HCPCS Level II codebook look for where the modifiers are listed and refer to modifier QX. QX is the correct modifier for CRNA services when medically directed by a physician.
What is the anesthesia code for a mediastinoscopy utilizing OLV (one lung ventilation)?
b. 00529
Response Feedback:
Rationale: In the CPT® Index look for Anesthesia/Mediastinoscopy directing you to codes 00528, 00529. These codes represent mediastinoscopy and diagnostic thoracoscopy. Review the codes in the numeric section to determine that 00529 describes the procedure utilizing one lung ventilation (OLV).
What are the three classifications of anesthesia?
d. General, Regional and Monitored Anesthesia Care
Response Feedback:
Rationale: An epidural is a type of regional anesthesia. Moderate or conscious sedation is typically provided by the same physician performing the service sedation supports and requires the presence of an independent observer to monitor the patient.
Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy.
d. 01963
Response Feedback:
Rationale: Use the CPT® Index look for Anesthesia/Hysterectomy/Cesarean which directs you to 01963, 01969. Review the codes in the numeric section to determine that code 01963 is the appropriate code. Note: Code 01969 is an add-on code and cannot be coded without a primary procedure code.
What time is used to report the start of anesthesia time?
a. When the anesthesiologist begins to prepare the patient for anesthesia
Response Feedback:
Rationale: Per Anesthesia Guidelines in the CPT® codebook under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room (or an equivalent area). Pre-anesthesia assessment time is not part of reportable anesthesia time, as it is considered in the base values assigned.
The patient had surgery to remove and replace an existing Hickman catheter. The anesthesiologist reported a postoperative diagnosis of a catheter related bloodstream infection (CRBSI). What ICD-10-CM code(s) is/are reported?
a. T80.211A
Response Feedback:
Rationale: A catheter related bloodstream infection (CRBSI) is a complication. In ICD-10-CM Alphabetic Index look for Infection/due to or resulting from/Hickman catheter/bloodstream which directs you to code T80.211-. In the Tabular List a 7 th character is required to complete the code. Character A is selected for initial encounter.
A 94 year-old patient is having surgery to remove his parotid gland with dissection and preservation of the facial nerve. The surgeon has requested the anesthesia department place an arterial line. What CPT® code(s) is/are reported for anesthesia?
a. 00100, 36620, 99100
Response Feedback:
Rationale: In the CPT® Index look for Anesthesia/Salivary Glands which directs you to code 00100. Reference the code in the numeric section to confirm that 00100 is the correct code. Hint - Coders may need to use the Surgery Section to determine that the parotid gland is included in the salivary glands. The arterial line placement is NOT included in the base value and may be reported separately with code 36200. In the CPT® Index look for Catheterization/Arterial System/Percutaneous. Due to patient’s advanced age of 94, qualifying circumstance add-on code 99100 is also reported. Furthermore, the patient’s age implies he is on Medicare, therefore we do not use Physical Status Modifiers as they are not accepted.
A 43 year-old patient with a severe systemic disease is having surgery to remove an integumentary mass from his neck. What CPT® code and modifier are reported for the anesthesia service?
a. 00300-P3
Response Feedback:
Rationale: Look in the CPT® Index for Anesthesia/Neck which directs you to codes 00300, 00320-00322, 00350-00352 or Anesthesia/Integumentary System/Neck which directs you to code 00300. Refer to the numeric section to determine that code 00300 is the correct code. Review the Anesthesia Guidelines in the CPT® codebook to determine that Physical Status Modifier P3 may be reported for a patient with severe systemic disease. The correct code is 00300-P3.
An anesthesiologist is medically supervising six cases concurrently. What modifier is reported for the anesthesiologist’s service?
a. AD
Response Feedback:
Rationale: In the HCPCS Level II codebook locate where the HCPCS Level II Modifiers are listed. An anesthesiologist who is medically supervising more than four concurrent anesthesia procedures uses modifier AD to report for the anesthesiologist supervision services. The anesthesia services performed by the CRNA are reported separately. The anesthesia modifier for the anesthesiologist depends on the number of concurrent cases.
Code 00940 Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix or endometrium); not otherwise specified has a base value of three (3) units. The patient was admitted under emergency circumstances, qualifying circumstance code 99140, which allows two (2) extra base units. A preanesthesia assessment was performed and signed at 2:00 a.m. Anesthesia start time is reported as 2:21 am, and the surgery began at 2:28 am. The surgery finished at 3:25 am and the patient was turned over to PACU at 3:36 am, which was reported as the ending anesthesia time. Using fifteen-minute time increments and a conversion factor of $100, what is the correct anesthesia charge?
b. $1,000.00
Response Feedback:
Rationale: Determining the base value is the first step in calculating anesthesia charges and payment expected. Time reporting is the second step. Per Anesthesia Guidelines in the CPT® codebook under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room (or an equivalent area) and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision. In the scenario above, base units equal three (3) plus two (2) emergency qualifying circumstances units (Base 3 + QC 2 = 5 units). Five (5) time units, in fifteen minute increments, is calculated by taking the anesthesia start time (2:21) and the anesthesia end time (3:36) and determining one hour 15 minutes (75/15 = 5) of total anesthesia time. Ten units (5 + 5 = 10) are then multiplied by the $100 conversion factor (10 X $100 = $1,000.00). Note: Base Unit Values are not separately listed in the CPT®. The American Society of Anesthesiologists (ASA) determines the base units’ values for anesthesia codes.
A CRNA is personally performing a case with medical direction from an anesthesiologist. What modifier is appropriately reported for the CRNA services?
d.
QX
Response Feedback:
Rationale: In the HCPCS Level II codebook locate where the HCPCS Level II Modifiers are listed. A CRNA with medical direction from an anesthesiologist is appropriately reported with modifier QX. Any time the CRNA is working with medical direction, the anesthesia procedure is reported with QX. The anesthesiologist reports QY if only directing one CRNA and QK if directing 2 to 4 CRNAs.
A 72 year-old patient is undergoing a corneal transplant. An anesthesiologist is personally performing monitored anesthesia care. What CPT® code and modifier(s) are reported for anesthesia?
b. 00144-AA-QS, 99100
Response Feedback:
Rationale: In the HCPCS Level II codebook locate where the HCPCS Level II Modifiers are listed. An anesthesiologist who is personally performing services reports the service with a modifier AA and when the service performed is Monitored Anesthesia Care (MAC) modifier QS is also reported. The modifiers are sequenced first by the anesthesia provider then the MAC modifier which are attached to the appropriate anesthesia code. The Qualifying Circumstances add-on code 99100 is assigned for extreme age of the patient being older than 70 years of age.
Mrs. Jones is a 90 year-old female having laparoscopic surgery on her gallbladder. Dr. Lot, the anesthesiologist for this case, documents she is a normal healthy person and begins to prepare the patient for surgery at 07:30 am. Surgery begins at 08:00 am. The surgery is concluded at 09:30 am. The anesthesiologist releases the patient to the PACU nurses at 09:45 am. How many minutes of anesthesia time transpired and what is the appropriate anesthesia code?
a.
2 hrs. 15 minutes, 00790-AA-P1, 99100
Response Feedback:
Rationale: Per Anesthesia Guidelines in the CPT® codebook under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in the operating room (or an equivalent area) and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision. In this case the start time is 07:30 am and the end time is 09:45 am equaling a total of 2 hours and 15 minutes or 145 minutes of total anesthesia time. In the CPT® Index look for Anesthesia/Abdomen/Intraperitoneal which directs you to code ranges 00790-00797, 00840-00851. Review the numeric section to determine that the correct code is 00790 as the gallbladder is located behind the liver in the upper abdomen. AA modifier is to indicate the anesthesiologist performed the procedure. The physical status modifier is P1 for a normal healthy patient and the Qualifying Circumstances due to the patient age of 90 should be coded to 99100. The correct reporting for this procedure is 00790-P1, 99100 for 2 hrs. 15 minutes.
