CPC Chapter 16- Anesthesia Review Questions

Question 1

Using the CPT® Index, look for anesthesia for a diagnostic thoracoscopy. Which of the following is the correct anesthesia code?
A. 00528
B. 00529
C. 00540
D. 00541

Answer 1

A. 00528

Rationale: Look in the CPT® Index for Anesthesia/Thoracoscopy. All of these codes are related to thoracoscopy. Code 00528 describes a diagnostic procedure not using one-lung ventilation (OLV) utilization.

Question 2

Using the CPT® Index, look for anesthesia for a modified radical mastectomy with internal mammary node dissection. Which of the following is the correct anesthesia code?
A. 00400
B. 00402
C. 00404
D. 00406

Answer 2

D. 00406

Using the CPT® Index, look for anesthesia for a modified radical mastectomy with internal mammary node dissection. Which of the following is the correct anesthesia code?

Question 3

Using the CPT® Index, locate the anesthesia code for laparoscopic cholecystectomy. Which of the following is the correct anesthesia code?
A. 00700
B. 00790
C. 00840
D. 00860

Answer 3

B. 00790

Rationale: A cholecystectomy is the surgical removal of the gallbladder. The gallbladder is an intraperitoneal organ located in the upper abdomen. Look in the CPT® Index for Anesthesia/Abdomen/Intraperitoneal directing you to code range 00790-00797, 00840-00851. A review of the codes verifies 00790 as the correct code. Another Index option is to look for Anesthesia/Laparoscopy.

Question 4

Using your CPT® Index, look for anesthesia for a diagnostic shoulder arthroscopy. Which of the following is the correct anesthesia code?
A. 01622
B. 01630
C. 01634
D. 01638

Answer 4

A. 01622

Rationale: There is no listing for Anesthesia/Diagnostic Arthroscopy in CPT® Index. Look for Anesthesia/Arthroscopic Procedures/Shoulder or Anesthesia/Shoulder/Arthroscopic Procedures. Both provide a range of code choices. Code 01622 identifies anesthesia for a diagnostic arthroscopic procedure of the shoulder joint.

Question 5

Report the appropriate anesthesia code(s) for a patient who had general anesthesia for a total shoulder replacement. At the surgeon’s request, the anesthesiologist placed a brachial plexus continuous catheter for postoperative pain management. The day after surgery, the patient was seen by the anesthesiologist for follow-up care. What is the correct CPT® coding for this encounter?
A. 01630, 64416-59, 01996
B. 01638, 64415-59
C. 01638, 64415-59, 01996
D. 01638, 64416-59

Answer 5

D. 01638, 64416-59

Rationale: In the CPT® Index locate Anesthesia/Replacement/Shoulder directing you to 01638. The brachial plexus block was requested for postoperative pain management and is appropriate to report separately. To find this code look in the Index for Brachial Plexus/Injection/Anesthetic directing you to 64415, 64416. Code 64415 does not specify the use of a continuous catheter. Code 01996 is reported with epidurals, not brachial plexus blocks. The correct answer is 01638, 64416-59. Modifier 59 is appended because nerve blocks are bundled with anesthesia codes. In this case, the block is for postoperative pain and is reported separately.

Question 6

Report the appropriate anesthesia code for an obstetric patient who had an epidural catheter placed during labor for a vaginal delivery. The catheter was dislodged and was replaced before the patient delivered a healthy baby girl.
A. 62320
B. 01967
C. 01967 X 2
D. 01961

Answer 6

B. 01967

Rationale: Look in the CPT® Index for Anesthesia/Childbirth/Vaginal Delivery directing you to 01960, 01967. Code 01960 is used for a vaginal delivery only while 01967 describes neuraxial labor anesthesia with replacement of the catheter if necessary. Code 01961 is used for a cesarean delivery. Code 62320 is not used by the anesthesiologist for an epidural for an obstetric patient.

Question 7

Using your ICD-10-CM Alphabetic Index, look for the diagnosis code for a patient with a postoperative diagnosis of pancreatic mass. Which of the following is the correct diagnosis code?
A. K86.89
B. D01.7
C. C25.9
D. D37.8

Answer 7

A. K86.89

Rationale: Look in the ICD-10-CM Alphabetic Index for Mass/pancreas; there is no listing for Mass/pancreas. Refer to Mass/specified organ NEC - see Disease, by site. Look for Disease/pancreas/specified NEC K86.89. The coder should not default to the Table of Neoplasms because the term is Mass, unless otherwise stated. Verify code selection in the Tabular List.

Question 8

Using your ICD-10-CM Alphabetic Index, look for the diagnosis code for a patient with a preoperative diagnosis of abdominal pain, right lower quadrant, and a postoperative diagnosis of uterine fibroids. Which of the following is the correct diagnosis code?
A. R10.9
B. R10.31
C. D26.9
D. D25.9

Answer 8

D. D25.9

Rationale: The preoperative diagnosis is disregarded because a more definitive diagnosis is determined following surgery. Look in the ICD-10-CM Alphabetic Index for Fibroid/uterus D25.9. Verify code selection in the Tabular List.

Question 9

A patient is scheduled for monitored anesthesia care (MAC) to remove an eyelid cyst. Normally the surgeon provides moderate sedation for the removal; however, this patient has a history of failed moderate sedation. Select the correct diagnosis code(s).
A. H02.829
B. H02.829, T88.52XA
C. H02.829, Z92.83
D. Z92.83

Answer 9

C. H02.829, Z92.83

Rationale: The reason for the anesthesiologist’s involvement for the monitored anesthesia care (MAC) in the surgery is the patient’s history of failed moderate sedation. The eyelid cyst is first listed as it is the medical necessity for the surgery and Z92.83 is an additional diagnosis to explain the need for anesthesia care. In the ICD-10-CM Alphabetic Index, look for Cyst/eyelid (sebaceous) directing you to H02.829. Next, look in the Alphabetic Index for History/personal (of)/failed conscious sedation directing you to Z92.83. Verify code selection in the Tabular List.

Question 10

A 74-year-old patient is scheduled for a total knee replacement due to degenerative joint disease (DJD) of his left knee. The patient had surgery in 2012 for gastroesophageal reflux disease (GERD). Select the correct diagnosis code(s).
A. K21.9
B. M25.462
C. M17.12
D. M17.12, K21.9

Answer 10

C. M17.12

Rationale: The patient’s previous surgery has no relevance to the anesthesia for the knee surgery. DJD is an abbreviation for degenerative joint disease. Look in the ICD-10-CM Alphabetic Index for Degeneration, degenerative/joint disease which directs you to see Osteoarthritis. Look in the Alphabetic Index for Osteoarthritis/knee M17.1. According to Coding Clinic, Volume 3, Number 4, Fourth Quarter 2016, “When the type of osteoarthritis is not specified, ‘primary’ is the default.” Look at M17.1 in the Tabular List and you will see Primary osteoarthritis of knee NOS. In the Tabular List, a 5th character is needed to report the laterality. Complete code is M17.12 for the left knee.

Question 11

Which of the following is the correct diagnosis coding to report a tibial closed fracture, proximal end, of the left leg, initial encounter?
A. S82.191A
B. S82.191B
C. S82.102A
D. S82.102B

Answer 11

C. S82.102A

Rationale: This is a closed fracture. Look in the ICD-10-CM Alphabetic Index for Fracture, traumatic/tibia/proximal end and you are directed to see Fracture, tibia, upper end. Fracture, traumatic/tibia/upper end directs you to code S82.10-. In the Tabular List, 6th character 2 is reported for the left leg and 7th character A is selected for a closed fracture, initial encounter.

Question 12

Which of the following is NOT included in the base unit value of anesthesia services?
A. Pre-anesthesia visit
B. Post-anesthesia visit
C. Arterial line placement
D. Routine monitoring

Answer 12

C. Arterial line placement

Rationale: The placement of an arterial line for intraoperative monitoring is not included in the base value services listed in the Anesthesia Guidelines.

Question 13

Which of the following best describes the start of anesthesia time?
A. During the pre-anesthesia visit
B. When the anesthesiologist begins to prepare the patient
C. When the surgeon begins to treat the patient
D. When the OR nurse calls start of room time

Answer 13

B. When the anesthesiologist begins to prepare the patient

Rationale: Anesthesia time begins when the anesthesia provider begins to prepare the patient for the induction of anesthesia.

Question 14

When more than one surgery is performed during a single anesthetic administration, which of the following is TRUE regarding the anesthesia code reported?
A. The anesthesia code representing the most complex procedure is reported.
B. An anesthesia code is reported for each separate surgery performed.
C. The anesthesia code representing the longest surgery is reported.
D. None of the above.

Answer 14

A. The anesthesia code representing the most complex procedure is reported.

Rationale: Only the anesthesia code representing the most complex procedure is reported. The most complex procedures usually have the highest base unit value.

Question 15

Which of the following physical status modifiers best describes a normal, healthy patient who is undergoing anesthesia?
A. P6
B. P4
C. P3
D. P1

Answer 15

D. P1

Rationale: A normal healthy patient is reported with physical status modifier P1. No additional value is recognized.

Question 16

A 67-year-old patient is undergoing anesthesia for a re-operation after a coronary bypass two months ago. Which of the following qualifying circumstances may be reported separately?
A. +99100
B. +99116
C. +99135
D. None of the above

Answer 16

D. None of the above

Rationale: Qualifying circumstances may not be separately reported if the anesthesia code already takes difficulty into consideration.

Question 17

Which of the following codes is used to report placement of a flow directed Swan-Ganz catheter?
A. 36160
B. 93503
C. 36013
D. 36556

Answer 17

B. 93503

Rationale: Look in the CPT® Index for Swan-Ganz Catheter/Insertion directing you to 93503 Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes.

Question 18

An anesthesiologist was called to the emergency room to intubate a patient with respiratory difficulty. Which CPT® coding is reported?
A. 31502
B. 43753
C. 36620
D. 31500

Answer 18

D. 31500

Rationale: The anesthesiologist is not providing an intubation for a patient undergoing anesthesia. An emergency intubation is correctly reported as 31500. Look in the CPT® Index for Intubation/Endotracheal Tube.

Question 19

A 42-year-old patient is having emergency surgery for a ruptured appendix. An anesthesiologist was not available to administer general anesthesia. The surgeon administers regional anesthesia with an epidural spinal block and performs the surgery. Which modifier indicates the surgeon administered the anesthesia?
A. 22
B. 23
C. 47
D. 59

Answer 19

C. 47

Rationale: Modifier 47 is reported by the surgeon when he also provides regional or general anesthesia for the surgical service. This does not apply to local anesthesia. Modifier 47 is added to the appendectomy code. This modifier is not to be reported with anesthesia CPT® procedure codes. Anesthesia providers do not report this modifier.

Question 20

A 78-year-old patient is undergoing lens surgery for cataracts. An anesthesiologist personally performed monitored anesthesia care (MAC). Which modifier(s) appropriately report(s) the anesthesiologist’s service?
A. 00142-QK
B. 00142-QS
C. 00142-AA-QS
D. 00142-AA

Answer 20

C. 00142-AA-QS

Rationale: An anesthesiologist who is personally performing administration of anesthesia reports the service with an AA modifier. Because the service was performed using MAC, a QS modifier is also reported.

Question 21

A 22-year-old patient delivered a healthy baby boy by cesarean delivery with general anesthesia. The anesthesiologist performed all required steps for medical direction and was medically directing two other cases concurrently. Which modifier(s) report(s) the anesthesiologist and CRNA services?
A. 01961-AA
B. 01961-QK and 01961-QX
C. 01961-QK and 01961-QZ
D. 01961-QY and 01961-QX

Answer 21

B. 01961-QK and 01961-QX

Rationale: An anesthesiologist who is medically directing reports the service separately from the CRNA, depending on the number of concurrent cases. Because there was more than one concurrent (QY) case and fewer than five concurrent (AD) cases, the appropriate modifiers to report are QK for the physician claim and QX for the CRNA claim. A QZ modifier is reported when indicating a case is performed by a CRNA without medical direction by a physician.

Question 22

An anesthesiologist is medically supervising five cases at the same time. Which modifier(s) report(s) the anesthesiologist and CRNA services?
A. AA and QZ
B. QK and QZ
C. AD (only)
D. AD and QX

Answer 22

D. AD and QX

Rationale: An anesthesiologist who is medically supervising reports the service separately from the CRNA. Supervision of more than four concurrent anesthesia procedures is reported with modifier AD. The CRNA reports with modifier QX.

Question 23

A CRNA is personally performing a case without medical direction from an anesthesiologist. Which modifier reports the CRNA services?
A. QX
B. QZ
C. QK
D. QS

Answer 23

B. QZ

Rationale: A CRNA without medical direction is reported with QZ modifier.

Question 24

A 69-year-old Medicare patient with a history of severe cardiopulmonary disease is undergoing surgery with monitored anesthesia care (MAC). Which modifier(s) is/are used for monitored anesthesia care service?
A. QS
B. G8
C. G9
D. G9 and QS

Answer 24

C. G9

Rationale: Anesthesia care for a Medicare patient who is undergoing MAC and has a history of severe cardiopulmonary disease is reported with modifier G9. The additional modifier QS is not necessary because the description for G9 includes monitored anesthesia care.

Question 25

What is the anesthesia code for a tubal ligation?
A. 00846
B. 00851
C. 00840
D. 00844

Answer 25

B. 00851

Rationale: In the CPT® Index, look for Anesthesia/Fallopian Tube/Ligation or Anesthesia/Tubal Ligation which directs you to 00851. Review the code in the numeric section to determine that 00851 describes the procedure.

Question 26

What are the three classifications of anesthesia?
A. General, MAC, and conscious sedation
B. General, regional, and epidural
C. General, regional, and monitored anesthesia care
D. General, regional, and moderate sedation

Answer 26

C. General, regional, and monitored anesthesia care

Rationale: The three classifications of anesthesia are general, regional, and monitored anesthesia care (MAC). 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.

Question 27

What is the anesthesia code for a shoulder arthroscopy which became an open procedure on the shoulder joint?
A. 01680
B. 01622
C. 01638
D. 01630

Answer 27

D. 01630

Rationale: In the CPT® Index, look for Anesthesia/Arthroscopic Procedures/Shoulder which directs you to code range 01622-01638. Review the codes in the numeric section to determine 01630 is the appropriate code selection because the description of the code includes open or surgical arthroscopic procedures.

Question 28

Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy.
A. 01963
B. 01962
C. 01969
D. 01967

Answer 28

A. 01963

Rationale: In 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.

Question 29

A 22-year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier is appended to the service?
A. 47
B. 23
C. 22
D. 52

Answer 29

B. 23

Rationale: In the CPT® code book go to Appendix A – Modifiers. Review the modifiers to determine that modifier 23 is reported to indicate a procedure not usually requiring anesthesia (either none or local) but due to unusual circumstances general anesthesia is necessary.

Question 30

What ICD-10-CM coding is reported for left knee primary osteoarthrosis?
A. M17.2
B. M17.0
C. M17.12
D. M17.5

Answer 30

C. M17.12

Rationale: Look in the ICD-10-CM Alphabetic Index for Osteoarthrosis and you are directed to see also Osteoarthritis. Look in the Alphabetic Index for Osteoarthritis/primary/knee, which directs you to code M17.1-. The Tabular List shows that a 5th character is required to identify laterality; select 2 for left knee.

Question 31

What anesthesia code(s) are assigned for an obstetric patient who had neuraxial labor analgesia provided by the anesthesiologist when the delivery was expected to be a normal vaginal delivery but the obstetrician performed a cesarean delivery when the fetal heart rate dropped?
A. 01968
B. 01967
C. 01967, 01968
D. 62326

Answer 31

C. 01967, 01968

Rationale: Look in the CPT® Index for Anesthesia/Neuraxial/Labor, which directs you to code range 01967-01969 and Anesthesia/Neuraxial/Cesarean Delivery 01968,01969. Review the codes in the numeric section to determine that codes 01967 and +01968 are the correct codes. Code 01967 describes the initial service without the cesarean delivery. Add-on code +01968 adds the cesarean delivery. Add-on codes must be coded in conjunction with the primary code and cannot be coded alone. The correct codes are 01967, +01968.

Question 32

What is the anesthesia code for an appendectomy?
A. 00862
B. 00860
C. 00790
D. 00840

Answer 32

D. 00840

Rationale: In the CPT® Index under Anesthesia you will not see the terms appendix nor appendectomy listed separately. Look for Anesthesia/Abdomen/Intraperitoneal, which directs you to code ranges 00790-00797, 00840-00851. Review the codes in the Tabular List to determine that code 00840 is the correct code. Note: You need to know that the appendix is an intraperitoneal organ of the lower abdomen.

Question 33

A patient has foot surgery for a right calcaneal spur. Chronic myocardial ischemia was listed on the pre-anesthesia assessment. What ICD-10-CM coding is reported?
A. M77.31, I25.9
B. M77.31, I25.89
C. M89.9
D. I24.0

Answer 33

A. M77.31, I25.9

Rationale: In the ICD-10-CM Alphabetic Index look for Spur, bone/calcaneal, which directs you to M77.3-. Next, in the Alphabetic Index look for Ischemia, ischemic/heart (chronic or with a stated duration of over four weeks), which directs you to I25.9. In the Tabular List confirm the code selection. Code M77.3- indicates that a 5th character is needed to define the laterality of the foot. For a calcaneal spur in the right foot report M77.31. The chronic myocardial ischemia code I25.9 denotes the anesthesia risk and is also reported.

Question 34

What is the ICD-10-CM coding for personal history of colonic polyps?
A. Z83.719
B. K51.418
C. K63.5
D. Z86.010

Answer 34

D. Z86.010

Rationale: In the ICD-10-CM Alphabetic Index look for History/personal (of)/disease or disorder (of)/digestive system/colonic polyp, which refers you to code Z86.010. Verify code selection in the Tabular List.

Question 35

A 42-year-old patient was admitted to an ASC and began having complications in the OR after the induction of anesthesia. The surgeon immediately discontinued the planned surgery. If the insurance company requires a reported modifier, what modifier best describes the extenuating circumstances for the anesthesiologist?
A. 74
B. 23
C. 53
D. 73

Answer 35

C. 53

Rationale: In the CPT® code book go to Appendix A and look for modifiers. Review the modifiers to determine that modifier 53 best describes the anesthesia service, which was discontinued prior to the start of surgery. Modifiers 73 and 74 are only reported by the facility for the use of the facility. These modifiers are never reported for physician anesthesia services. Modifier 73 is utilized by the facility when the procedure is cancelled prior to anesthesia induction and modifier 74 is used when the procedure is cancelled after anesthesia induction. The guidelines associated with both modifiers 73 and 74 state, “For physician reporting of a discontinued procedure, see modifier 53.” The anesthesiologist will report the intended anesthesia code with the start and stop anesthesia time. Modifier 23 is used to report unusual anesthesia, such as the need for general anesthesia in a case that is usually done with no anesthesia or only a local.

Question 36

What is the appropriate code for a patient who had regional block anesthesia provided for carpal tunnel surgery?
A. 64417
B. 01820
C. 20526
D. 01810

Answer 36

D. 01810

Rationale: In this example it is important to understand the type of anesthesia (regional block) is determining the anesthesia code. When a nerve block is used as the sole form of anesthesia, the anesthesia code is reported rather than the nerve block CPT code. In the CPT® Index look for Anesthesia/Arm/Lower, which directs you to code ranges 00400, 01810-01820, 01830-01860. Review the codes in the numeric section to determine code 01810 is correct. You must know that carpal tunnel surgery refers to the median nerve in the wrist. Hint: Try looking up the surgical code for clues to the anatomical area when necessary for assistance.

Question 37

What is the anesthesia code for an insertion of a penile prosthesis performed via a perineal approach?
A. 00934
B. 00932
C. 00938
D. 00936

Answer 37

C. 00938

Rationale: In the CPT® Index look for Anesthesia/Penis, which directs you to code range 00932-00938. Review the code range in the Tabular List to determine 00938 is the appropriate code selection.

Question 38

The patient is receiving a cast change for a compound left trimalleolar fracture (ankle). What ICD-10-CM coding is reported?
A. S82.851S
B. S82.852E
C. S89.302S
D. S82.892D

Answer 38

B. S82.852E

Rationale: In the ICD-10-CM Alphabetic Index look for Fracture, traumatic/ankle/trimalleolar (displaced), which directs you to code S82.85-. In the Tabular List it indicates the code requires a 6th character for the laterality and a 7th character for the episode of care. The 6th character 2 is for the left ankle and the 7th character E is for subsequent care with routine healing for an open fracture type 1 or type 2, which includes open fracture NOS. This was a compound fracture, which is an open displaced fracture. The correct code is S82.852E. According to ICD-10-CM guideline I.C.19.c., a fracture not indicated whether displaced or not displaced should be coded to displaced. According to ICD-10-CM guideline I.C.19.a., an example of subsequent care is a cast change.

Question 39

What ICD-10-CM coding is reported for an uncomplicated incomplete abortion?
A. O20.0
B. O03.4
C. O03.9
D. O04.80

Answer 39

B. O03.4

Rationale: Look in the ICD-10-CM Alphabetic Index for Abortion/incomplete (spontaneous,) which directs you to code O03.4. Verify code selection in the Tabular List. Note that spontaneous is a nonessential modifier to Abortion.

Question 40

A 59-year-old patient is having surgery on the pericardial sac, without use of a pump oxygenator. The perfusionist placed an arterial line. What CPT® coding is reported for anesthesia?
A. 00561
B. 00560
C. 00562
D. 00560, 36620

Answer 40

B. 00560

Rationale: In the CPT® Index look for Anesthesia/Heart, which directs you to codes 00560-00567, 00580 or look for Anesthesia/Intrathoracic System which directs you to multiple code ranges. Refer to the numeric section to determine 00560 is the correct code for without use of a pump oxygenator. The arterial line placement (36620) was not provided by the anesthesiologist.

Question 41

An 11-month-old patient presented for emergency surgery to repair a severely broken arm after falling from a third story window. What qualifying circumstance code(s) may be reported in addition to the anesthesia code?
A. 99116
B. 99100, 99140
C. 99140
D. 99100

Answer 41

B. 99100, 99140

Rationale: In the CPT® anesthesia guidelines under Qualifying Circumstances each of the qualifying circumstances codes identifies a different circumstance, and more than one may be appended when applicable, unless the reported anesthesia code already contains the risk factor. In this case, 99100 is assigned for extreme age of one year or younger and 99140 is assigned for emergency conditions. Note: Qualifying circumstances codes may also be found in the CPT® Medicine subheading Miscellaneous Services/Qualifying Circumstances for Anesthesia.

Question 42

A 43-year-old patient with a severe systemic disease is having surgery to remove an integumentary mass from his neck. What CPT® coding and modifier are reported for the anesthesia service?
A. 00300-P2
B. 00300-P3
C. 00322-P3
D. 00350-P3

Answer 42

B. 00300-P3

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® code book to determine that physical status modifier P3 may be reported for a patient with severe systemic disease. The correct code is 00300-P3.

Question 43

A 94-year-old Medicare 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. Report the CPT® code(s) for anesthesia?
A. 00400
B. 00100, 99100
C. 00300, 36620
D. 00100, 36620, 99100

Answer 43

D. 00100, 36620, 99100

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 36620. 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, because the patient is a Medicare beneficiary, we do not use Physical Status Modifiers as they are not accepted by Medicare.

Question 44

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. PS 4 was assigned by the anesthesiologist. 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?
A. $1,000.00
B. $800.00
C. $1,200.00
D. $900.00

Answer 44

C. $1,200.00

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® code book 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, plus two (2) units for P4 (Base 3 + QC 2 + P4 2 = 7 units). Five (5) time units, in 15-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. 12 units (7 + 5 = 12) are then multiplied by the $100 conversion factor (12 X $100 = $1,200.00). Note: Base unit values are not separately listed in CPT®. The American Society of Anesthesiologists (ASA) determines the base unit value for anesthesia codes.

Question 45

Anesthesia start time is reported as 7:14 am, and the surgery began at 7:26 am. The surgery finished at 8:18 am and the patient was turned over to PACU at 8:29 am, which was reported as the ending anesthesia time. What is the anesthesia time reported?
A. 7:26 am to 8:18 am (52 minutes)
B. 7:26 am to 8:29 am (63 minutes)
C. 7:14 am to 8:18 am (64 minutes)
D. 7:14 am to 8:29 am (75 minutes)

Answer 45

D. 7:14 am to 8:29 am (75 minutes)

Rationale: Per anesthesia guidelines in the CPT® code book 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. Anesthesia start time (7:14) and anesthesia end time (8:29) calculates as 1 hour and 15 minutes or 75 minutes of total anesthesia time.

Question 46

Code 00350 Anesthesia for procedures on major vessels of the neck; not otherwise specified has a base value of ten (10) units. The patient is physical status P3, which allows one (1) extra base unit. Anesthesia start time is reported as 11:02 am, and the surgery began at 11:14 am. The surgery finished at 12:34 pm and the patient was turned over to PACU at 12:47 pm, 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?
A. $1,500.00
B. $1,700.00
C. $1,600.00
D. $1,800.00

Answer 46

D. $1,800.00

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® code book 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 ten (10) plus one (1) physical status modifier unit (Base 10 + PS 1 = 11 units). Seven (7) time units, in fifteen-minute increments, is calculated by taking the anesthesia start time (11:02) and the anesthesia end time (12:47) and determining 1 hour 45 minutes or 105 minutes of total anesthesia time (105/15 = 7). Eighteen units (11 + 7 = 18) are then multiplied by the $100 conversion factor (18 X $100 = $1,800.00). Note: Base unit values are not separately listed in CPT®. The American Society of Anesthesiologists (ASA) determines the base unit value for anesthesia codes.

Question 47

A 5-year-old patient is experiencing atrial fibrillation with rapid ventricular rate. The anesthesia department is called to insert a nontunneled central venous (CV) catheter. What CPT® coding is reported?
A. 36556
B. 36557
C. 00400
D. 36555

Answer 47

A. 36556

Rationale: This is NOT anesthesia care so a code from the Surgery section of CPT® is appropriate. In the CPT® Index look for Catheterization/Central Venous, which directs you to see Central Venous Catheter Placement. Look in the CPT® Index for Central Venous Catheter Placement/Insertion/Central/Non-tunneled, which directs you to codes 36555, 36556. Review the numeric section to determine the correct code is 36556 for the 5-year-old patient. Note the type of insertion and the age of the patient to make the correct choice of codes.

Question 48

A patient presents to the OR for a craniotomy with evacuation of a hematoma. What CPT® coding is reported for the anesthesiologist’s services?
A. 00210
B. 61314
C. 61312
D. 00211

Answer 48

D. 00211

Rationale: Look in the CPT® Index for Anesthesia/Head which directs you to codes 00210-00222, 00300 or Anesthesia/craniotomy which directs you to code 00211. Review the numeric section to determine that the correct code is 00211 as it includes verbiage for the evacuation of a hematoma.

Question 49

An 8 month old has a simple Fontan procedure to repair his tricuspid atresia. During the procedure, the heart-lung machine is used. What are the correct CPT® and ICD-10-CM codes for this anesthesia service?
A. 00561, 99100, 99116, Q22.3
B. 00561, Q22.4
C. 00562, 99100, Q21.0
D. 00561, 99100, Q22.4

Answer 49

B. 00561, Q22.4

Rationale: In the CPT® Index look for Anesthesia/Heart, which directs you to codes 00560-00567, 00580. Refer to the numeric section to determine that the code 00561 is the correct code for a child less than 1 year of age when a pump oxygenator is used. The parenthetical note under the code states it is not to be used with the qualifying circumstance codes of +99100, +99116, and +99135. In the ICD-10-CM Alphabetic Index look for Atresia/tricuspid valve which refers you to Q22.4. Verify code selection in the Tabular List.