Chapter 3

1. Chapter 3 Anesthesia

2. Providers of Anesthesia • Who can perform Anesthesia? • A anesthesiologist, certified registered nurse anesthetists (CRNA’s) or anesthesiologist assistants (AA’s) can perform anesthesia.

3. Codes • Anesthesia code range is 00100-01999. • These codes are arranged by body site first beginning with the head, and then by the specific procedure performed. • These codes may be found in the alphabetical index under anesthesia or analgesia.

4. Types of Anesthesia • Local anesthesia: injection of a numbing agent directly into the area of the body to block the pain in minor procedures. • Regional anesthesia: this injection is applied to a larger area of body surface. Example would be a epidural or a spinal block. • General anesthesia: anesthetic is administered intravenously or inhaled. The patient is unconscious during the surgery.

5. How to find your code • Anesthesia for diagnostic arthoscopy of the knee. • 1. Look in the alphabetic index, under anesthesia. • 2. Look for subterm Arthroscopic Procedures and find knee. • 3. Code choices should be 01382, 01400. • 4. Look at both codes and pick the best one.

6. 01382 is your answer!!!!!!!

7. Conscious Sedation • This produces a level of consciousness that retains the patient’s ability to independently and continuously maintain a airway and respond appropriately to physical stimulation or verbal command. • If done by a physician performing the procedure requiring moderate conscious sedation use 99143-99145. If done by a physician other than the healthcare professional performing the procedure requiring conscious sedation use 99148-99150.

8. Beginning and Ending Time • Anesthesia begins when the anesthesiologist starts to prep the patient for induction of anesthesia (usually in the operating room). • Anesthesia ends when the anesthesiologist is no longer in attendence.

9. Modifiers • Physical status modifiers indicate the patient’s condition and therefore the complexity of the anesthesia service. • Physical status modifiers are assigned during the pre-anesthesia interview with the patient. • P1- normal, healthy P2- mild systemic disease • P3- severe systemic disease • P4- severe systemic disease, but constant threat to life • P5- moribund patient not expected to survive without surgery • P6- brain dead patient, organ donation

10. Other Modifiers • Other modifiers used with anesthesia are: • -22 • -23 • -51 • -53 • -59 • Look each modifier up in your CPT book!

11. HCPCS Level II Modifiers • When coding HCPCS level II codes you may need to use the following modifiers: • AA QY • AD • G8 • G9 • QK • QS Look these modifiers up in the HCPCS book.

12. Specific to CRNA coding • When a CRNA is providing anesthesia you may use the following modifiers: • QX- CRNA service with direction of a physician. • QZ- CRNA service without direction of a physician.

13. Other codes used to Report Circumstances • Sometimes there are unusual circumstances surrounding the patient’s condition. • 99100- reports a patient under 1 year or over 70 years old. • 99116- reports complication due to body hypothermia. • 99135- reports complication due to hypotension. • 99140- reports complication of emergency conditions.

14. Calculating Fees • The charge for anesthesia is based on the following formula: • Base unit + time unit + modifying factors X conversion factor. • Example: • (5 base units+8 time units+1 modifying factor) X $50

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