Sei sulla pagina 1di 31
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA
By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
ANESTHESIA By: Naser C. Masilam, RN
INTRODUCTION  Anesthesia codes grouped anatomically, are beginning with the head.  Many anesthesia codes
INTRODUCTION  Anesthesia codes grouped anatomically, are beginning with the head.  Many anesthesia codes
INTRODUCTION  Anesthesia codes grouped anatomically, are beginning with the head.  Many anesthesia codes
INTRODUCTION  Anesthesia codes grouped anatomically, are beginning with the head.  Many anesthesia codes

INTRODUCTION

Anesthesia

codes

grouped

anatomically,

are

beginning with the head.

Many anesthesia codes indicate “not other wise specified” for example, code 00920 describes

anesthesia for procedures on male genitalia

(including open urethral procedures) ; not other wise specified.

Coders either look for anesthesia in the CPP Index to locate correct anatomical area, or turn to Anesthesia 00100 00210 Section in CPP and look

under appropriate anatomic heading.

INTRODUCTION  Keep in mind, codes are not always found under the surgical description and
INTRODUCTION  Keep in mind, codes are not always found under the surgical description and
INTRODUCTION  Keep in mind, codes are not always found under the surgical description and
INTRODUCTION  Keep in mind, codes are not always found under the surgical description and

INTRODUCTION

Keep in mind, codes are not always found under the surgical description and the coder may need to default backward to find the most accurate

description.

For example, code ranges for anesthesia for a simple MASTECTOMY are not listed under

anesthesia for a simple MASTECTOMY are not listed under mastectomy , but rather under BREAST .

mastectomy , but rather under BREAST.

the

liver

is

under mastectomy , but rather under BREAST . the liver is in  Although, located the

in

Although,

located

the upper

abdomen, the harvesting of a liver is reported

with code

harvesting of organ(s) from a brain dead patient, which is listed under “Other Procedures”.

01990

Physiological

support

for

TYPES OF

ANESTHESIA

TYPES OF ANESTHESIA GENERAL ANESTHESIA “It is a drug induced that can loss consciousness.”
GENERAL ANESTHESIA
GENERAL ANESTHESIA

“It is a drug

induced that can loss consciousness.”

TYPES OF ANESTHESIA GENERAL ANESTHESIA “It is a drug induced that can loss consciousness.”
TYPES OF ANESTHESIA GENERAL ANESTHESIA “It is a drug induced that can loss consciousness.”

TYPES OF

ANESTHESIA

REGIONAL ANESTHESIA
REGIONAL ANESTHESIA

It losses sensation in a specific region of the

body, using techniques

such as:

Spinal Anesthesia

Epidural Anesthesia

Nerve

block/

Local

nerve block

of the body, using techniques such as: • Spinal Anesthesia • Epidural Anesthesia • Nerve block/
of the body, using techniques such as: • Spinal Anesthesia • Epidural Anesthesia • Nerve block/
of the body, using techniques such as: • Spinal Anesthesia • Epidural Anesthesia • Nerve block/
of the body, using techniques such as: • Spinal Anesthesia • Epidural Anesthesia • Nerve block/
of the body, using techniques such as: • Spinal Anesthesia • Epidural Anesthesia • Nerve block/

TYPES OF

ANESTHESIA

TYPES OF ANESTHESIA MONITORED ANESTHESIA CARE • The patient is under light sedation or no sedation

MONITORED ANESTHESIA CARE

•

The patient is under light sedation or

no sedation while undergoing surgery with local anesthesia provided by the surgeon.

The service is monitored by an anesthesia provider who is at all times prepared to convert MAC to General Anesthesia if necessary.

Local Anesthesia is not reported using anesthesia codes. It included in the Surgical Package and not recorded separately.

Anesthesia is not reported using anesthesia codes. It included in the Surgical Package and not recorded
Anesthesia is not reported using anesthesia codes. It included in the Surgical Package and not recorded

ANESTHESIA PROVIDERS

ANESTHESIOLOGIST
ANESTHESIOLOGIST

He

is

a

physician

to

practice

medicine

and

who

is

completed

an

accredited anesthesiology

program.

Personally performed

Medically direct

Medically supervised

members

anesthesia care team

of

an

program. • Personally performed • Medically direct • Medically supervised members anesthesia care team of an
program. • Personally performed • Medically direct • Medically supervised members anesthesia care team of an

ANESTHESIA

PROVIDERS

ANESTHESIA PROVIDERS CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) Completed an accredited anesthesia nurse program: •

CERTIFIED REGISTERED NURSE ANESTHETIST

(CRNA)
(CRNA)

Completed an accredited anesthesia nurse program:

Maybe either directed by an anesthesiologist

or non medically

directed

an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
an accredited anesthesia nurse program: • Maybe either directed by an anesthesiologist or non medically directed
ANESTHESIA PROVIDERS ANESTHESIOLOGIST ASSISTANT (AA) He is healthcare professional completed an accredited anesthesia
ANESTHESIA PROVIDERS ANESTHESIOLOGIST ASSISTANT (AA) He is healthcare professional completed an accredited anesthesia
ANESTHESIA PROVIDERS ANESTHESIOLOGIST ASSISTANT (AA) He is healthcare professional completed an accredited anesthesia
ANESTHESIA PROVIDERS ANESTHESIOLOGIST ASSISTANT (AA) He is healthcare professional completed an accredited anesthesia

ANESTHESIA PROVIDERS

ANESTHESIOLOGIST
ANESTHESIOLOGIST
ASSISTANT (AA)
ASSISTANT
(AA)

He is healthcare

professional

completed an accredited anesthesia

assistant training

program. May only be

medically directed by

an anesthesiologist.

completed an accredited anesthesia assistant training program. May only be medically directed by an anesthesiologist.

ANESTHESIA

PROVIDERS

ANESTHESIA RESIDENT
ANESTHESIA RESIDENT

Completed medical degree currently in a residency program specifically for anesthesiology training .

ANESTHESIA RESIDENT Completed medical degree currently in a residency program specifically for anesthesiology training .
ANESTHESIA RESIDENT Completed medical degree currently in a residency program specifically for anesthesiology training .

ANESTHESIA

PROVIDERS

STUDENT REGISTERED NURSE ANESTHETIST (SRNA)
STUDENT REGISTERED
NURSE ANESTHETIST
(SRNA)

Training in an

accredited nurse anesthesia program

ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program
ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program
ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program
ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program
ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program
ANESTHESIA PROVIDERS STUDENT REGISTERED NURSE ANESTHETIST (SRNA) Training in an accredited nurse anesthesia program

ANESTHESIA CODING

TERMINOLOGY

One Lung Ventillation

Pump Oxygenator

Intra- Peritoneal

Extra Peritoneal (Retroperitonel)

Radical

Diagnostic/ Surgical Arthroscopic Procedure

Peritoneal  Extra – Peritoneal (Retroperitonel)  Radical  Diagnostic/ Surgical Arthroscopic Procedure
Peritoneal  Extra – Peritoneal (Retroperitonel)  Radical  Diagnostic/ Surgical Arthroscopic Procedure
Peritoneal  Extra – Peritoneal (Retroperitonel)  Radical  Diagnostic/ Surgical Arthroscopic Procedure
Peritoneal  Extra – Peritoneal (Retroperitonel)  Radical  Diagnostic/ Surgical Arthroscopic Procedure
CPT CODING  Includes:  All usual pre operative and post operative visits  Anesthesia
CPT CODING  Includes:  All usual pre operative and post operative visits  Anesthesia
CPT CODING  Includes:  All usual pre operative and post operative visits  Anesthesia
CPT CODING  Includes:  All usual pre operative and post operative visits  Anesthesia

CPT CODING

Includes:

All usual pre operative and post operative visits

Anesthesia care during the procedure

Administration of fluids and/or blood products during surgery

Non- invasive monitoring (ECG, Temperature, Blood Pressure, Pulse Oxymetry, Capnography and Mass

Spectrometry)

forms

Unusual

of

monitoring

for

example,

arterial lines, central venous and pulmonary

artery catheter (Swan Ganz) are not included in the base unit value of anesthesia codes.

CPT CODING  Anesthesia Time begins when the anesthesiologist begins to prepare the patient for
CPT CODING  Anesthesia Time begins when the anesthesiologist begins to prepare the patient for
CPT CODING  Anesthesia Time begins when the anesthesiologist begins to prepare the patient for

CPT CODING

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

Pre Anesthesia Assessment Time is not part of reportable anesthesia time.

Anesthesia time ends when the anesthesiologist is no longer in personal attendance, and generally is reported when the patient is safely placed under post operative supervision.

 The surgical time does not play a role in determining anesthesia time.
 The surgical time does not play a role in
determining anesthesia time.

CPT CODING

Only one anesthesia code is reported during anesthesia administration, except in a case where there is an anesthesia add on code.

 For example, the anesthesia section of CPT has add on codes listed under Burn
 For example, the anesthesia section of CPT
has add on codes listed under Burn Excision
or Debridement and Obstetric.
 These
add
on
procedures
may not be
reported alone; they must be reported with
the
applicable
primary
anesthesia
code
referenced in parenthesis.
not be reported alone; they must be reported with the applicable primary anesthesia code referenced in
not be reported alone; they must be reported with the applicable primary anesthesia code referenced in
PHYSICAL STATUS MODIFIER  P1 a normal healthy patient  P2 a patient with mild
PHYSICAL STATUS MODIFIER  P1 a normal healthy patient  P2 a patient with mild
PHYSICAL STATUS MODIFIER  P1 a normal healthy patient  P2 a patient with mild

PHYSICAL STATUS MODIFIER

P1 a normal healthy patient

 P2 a patient with mild systemic disease  P3 a patient with severe systemic
 P2 a patient with mild systemic disease
 P3 a patient with severe systemic disease
 P4 a patient with severe systemic disease that is a
constant threats to life
 P5 a moribund patient who is not expected to
survive without the operation
 P6 a declared brain dead patient who’s organs are
being removed for donor purposes
QUALIFYING CIRCUMSTANCES  +99100 – Anesthesia for patient of extreme age, younger than 1 year
QUALIFYING CIRCUMSTANCES  +99100 – Anesthesia for patient of extreme age, younger than 1 year
QUALIFYING CIRCUMSTANCES  +99100 – Anesthesia for patient of extreme age, younger than 1 year

QUALIFYING CIRCUMSTANCES

 +99100 – Anesthesia for patient of extreme age, younger than 1 year and older
 +99100 – Anesthesia for patient of extreme age,
younger than 1 year and older than 70 – 1 extra
unit.
 +99116 – Anesthesia complicated by utilization of
total body hypothermia – 5 extra units.
 +99135 – Anesthesia complicated by utilization of
controlled hypotension – 5 extra units.
 +99140 - Anesthesia complicated by emergency
condition (specify) – 2 extra units.
QUALIFYING CIRCUMSTANCES  Documentation must support the qualifying circumstance code reported. An emergency is
QUALIFYING CIRCUMSTANCES  Documentation must support the qualifying circumstance code reported. An emergency is
QUALIFYING CIRCUMSTANCES  Documentation must support the qualifying circumstance code reported. An emergency is

QUALIFYING CIRCUMSTANCES

Documentation must support the qualifying circumstance code reported. An emergency is

defined as existing with a delay in the treatment

of the patient with lead to a significant increase in a threat to the patients life or body parts.

 Highlight parenthetical notes pertaining to use of qualifying circumstance codes with the CPT codes
 Highlight parenthetical notes pertaining to use of
qualifying circumstance codes with the CPT codes
for anesthesia service . For example, following
code 0036, it states “DO NOT REPORT 00326 in
conjunction with 99100”.

CPT MODIFIERS

Modifier 23 Unusual Anesthesia  Describe a procedure usually not requiring anesthesia, but, due to
Modifier 23 Unusual Anesthesia
 Describe a procedure usually not requiring
anesthesia, but, due to unusual circumstances, is
performed under general anesthesia. For
example, a pediatric patient may require general
anesthesia for the surgeon to perform a
procedure not requiring anesthesia under usual
circumstances.
require general anesthesia for the surgeon to perform a procedure not requiring anesthesia under usual circumstances.
require general anesthesia for the surgeon to perform a procedure not requiring anesthesia under usual circumstances.

CPT MODIFIERS

Modifier 47 Anesthesia by Surgeon
Modifier 47 Anesthesia by Surgeon
 It should not be appended to anesthesia codes (00100-01999).
 It should not be appended to anesthesia codes
(00100-01999).
CPT MODIFIERS Modifier 47 Anesthesia by Surgeon  It should not be appended to anesthesia codes
CPT MODIFIERS Modifier 47 Anesthesia by Surgeon  It should not be appended to anesthesia codes

CPT MODIFIERS

Modifier 53 Discontinued Procedure
Modifier 53 Discontinued Procedure
Describe a procedure started and, due to extenuating circumstances, discontinued.
Describe a procedure started and,
due to extenuating circumstances,
discontinued.
Modifier 53 Discontinued Procedure Describe a procedure started and, due to extenuating circumstances, discontinued.

CPT MODIFIERS

Modifier 59 Distinct Procedural Service

CPT MODIFIERS Modifier 59 Distinct Procedural Service This modifier is often appended to post pain operative
This modifier is often appended to post pain operative management services to indicate it is
This modifier is often appended to
post pain operative management
services to indicate it is separate
from the anesthesia administered
during the surgery.
post pain operative management services to indicate it is separate from the anesthesia administered during the

CPT MODIFIERS

Modifier 73 Discontinued Out – Patient Hospital – ASC procedure prior to administration of
Modifier 73 Discontinued Out –
Patient Hospital – ASC procedure
prior to administration of
anesthesia
anesthesia
CPT MODIFIERS Modifier 73 Discontinued Out – Patient Hospital – ASC procedure prior to administration of

CPT MODIFIERS

Modifier 74 Discontinued Out- Patient Hospital - ASC
Modifier 74 Discontinued Out-
Patient Hospital - ASC

procedure after to administration of anesthesia

CPT MODIFIERS Modifier 74 Discontinued Out- Patient Hospital - ASC procedure after to administration of anesthesia
CPT MODIFIERS Modifier 74 Discontinued Out- Patient Hospital - ASC procedure after to administration of anesthesia

DIRECTION, SUPERVISION AND MONITORING

Medical direction occurs when an anesthesiologist is involved in 2,3 or 4 anesthesia procedure at the same time; or a single anesthesia procedure with a qualified anesthesia residence, CRNA, or AA.

According to the centers, for Medicare and Medicaid services, when an anesthesiologist is medically directing, he or she must:

1.

Perform a pre anesthetic assessment and evaluation

2.

Prescribe an anesthesia plan

3.

Personally participate in the most demanding procedures of the anesthesia plan

including, if applicable, induction and emergence

4.

Ensure that the all the procedure in the anesthesia plan that he/ she does not perform are performed by a qualified anesthetist

5.

Monitor the course of anesthesia administration at frequent intervals

6.

Remain physically present and available for immediate diagnosis and treatment of emergencies

7.

Provide the indicated post anesthesia care.

If one or more of the above services is not performed by the anesthesiologist, the service is not considered medical direction .

or more of the above services is not performed by the anesthesiologist, the service is not

DIRECTION, SUPERVISION AND MONITORING

While medically directing, the anesthesiologist should not provide services to other patient. However, anesthesiologist

are allowed to provide the following to other patient without

affecting their ability to provide medical direction:

Addressing an emergency in short duration in the immediate area

Administering in epidural or caudal anesthetic to ease labor pain

Periodic rather than continuous monitoring of an obstetrical

patient

Receiving patient entering the operating suite for the next surgery

Checking on discharging patient from the post anesthesia unit

Coordinating scheduling matters

the next surgery  Checking on discharging patient from the post anesthesia unit  Coordinating scheduling
DIRECTION, SUPERVISION AND MONITORING  MAC is the intra – operative monitoring by an anesthesiologist
DIRECTION, SUPERVISION AND MONITORING  MAC is the intra – operative monitoring by an anesthesiologist
DIRECTION, SUPERVISION AND MONITORING
DIRECTION, SUPERVISION AND
MONITORING

MAC is the intra operative monitoring by an anesthesiologist or qualified individual

under the direction of an anesthesiologist

of a patient vital physiological signs, in

participation of:

The need for administration of general anesthesia;

Development of advance physiological reaction to the surgical procedure

DIRECTION, SUPERVISION AND MONITORING

Includes the performance of the following by the anesthesiologist or qualified individual under the

direction of an anesthesiologist;

1.

Pre anesthetic examination and evaluation

2.

Prescription of the anesthesia care required

3.

Completion of an anesthesia record

4.

Administration of any necessary oral and parenteral

medications

5.

Provision of indicated post operative anesthesia

care

of any necessary oral and parenteral medications 5. Provision of indicated post operative anesthesia care
HCTCS LEVEL 2 MODIFIERS anesthesia services performed  AA personally by – anesthesiologist  AD
HCTCS LEVEL 2 MODIFIERS anesthesia services performed  AA personally by – anesthesiologist  AD
HCTCS LEVEL 2 MODIFIERS
HCTCS LEVEL 2 MODIFIERS

anesthesia

services

performed

AA

personally

by

anesthesiologist

AD medical supervision: more than 4 concurrent anesthesia procedure

QA

concurrent

medical

direction

of

2,3

4

or

anesthesia procedure involving individuals

QY medical direction of CRNA by an anesthesiologist

this

service

has been performed in part by

GC

a

resident under the direction of a teaching physician

HCTCS LEVEL 2 MODIFIERS
HCTCS LEVEL 2 MODIFIERS

Most anesthesia modifier are reported only with anesthesia codes; they are not listed

with others CPT code categories.

Most anesthesia modifier are reported only with anesthesia codes; they are not listed with others CPT
Most anesthesia modifier are reported only with anesthesia codes; they are not listed with others CPT
Most anesthesia modifier are reported only with anesthesia codes; they are not listed with others CPT

THANK YOU

FOR LISTENING!!

THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!
THANK YOU FOR LISTENING!!