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.