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Bill 12
| Question | Answer |
|---|---|
| Endotracheal | anesthesia is accomplished by insertion of a tube into the nose or mouth, and passing the tube into the trachea for ventilation |
| Epidural | anesthesia is the injection of an anesthetic agent into the epidural spaces between the vertebrae, also known as the peridural, or epidural block. |
| Spinal | or intraspinal anesthesia refers to anesthesia produced by an injection of local anesthetic into the subarachnoid space around the spinal chord. |
| General | anesthesia is a state of unconsciousness that is accomplished by the use of a drug or combination of druges administered intramuscularly, rectally, intravenously, or by inhalation |
| Local | anesthesia can be accomplished by means of application of an anesthetic agent such as lidocaine placed directly on the area involved topical anesthesia or local infiltration through subcutaneous injection of an anesthetic agent. |
| Lidocaine can be | subcutaneously injected. |
| Blood patch also known as a | epidudural blood patch EBP not a type of anesthesia procedure for tx of a postdural puncture headache |
| Blood patch procedure | is when a cerebrospinal fluid leak is closed by means of an injection of the patients blood into the epidural space at or near the area of the dural puncdture that was accessed during spinal anesthesia |
| Blood patch is performed with | epidural or spinal anesthesia |
| Patient Controlled analgesia PCA is a | system that allows the patient to administer an analgesic drug such as morphine to control pain. A device is attached to a pump holding the drug and the pt can depress a handheld button to administer a dose of the drug. |
| PCA patient controlled analgesia is considered a hospital service and not generally reported by a | physician |
| Monitored Anesthesia Care MAC | is proided by an anesthesia provider who constantly monitors the pts vitals in oreder to assess vital functions as well as pain control hemodynamic or physiologic issues and who must be prepared to covert from monitored anesthesia care to general anesthe |
| Specific HCPCS Level II anesthesia modifiers which identify the anesthesia servics as moniterd MACare are appended to the | Anesthesia CPT code |
| Modifer _________ reports the anesthesia care as a MAC service Monitored Anesthesia Care | modifer QS |
| When the surgical procedure documentation for pt receiving MAC services indicates that the surgical procedure is deep, complex , comp;icated or markedly invasive modifer _______ is used | modifer G8 |
| The G8 modifer may only be applied to anesthesia CPT codes | 00100, 00300, 00400 00160, 00532 and 00920 |
| When MAC services are provided to a pt with a hx of sever cardiopulmonary disease modifier | modifer G9 should be reported with the anesthesia CPT coderather than modifier QS |
| General Anesthesia used for cases that require | deep sedation, like open heart surgery or complicated abdominal surgery. The pt is usually intubated. The pt is in a deep state of sedation and is not arousable or able to communicate or follow commands. |
| Several different types of medication may be used during general anesthesia including drugs for | analgesia/pain relief, sedation, amnesiacs/to lessen awareness, and paralytics for muscle relaxation to prevent movement or reflexive action by the pt during procedures. |
| Regional anesthesia uses | injection to target the nerves of the area being treated. |
| Spinal and epidural anesthesia is administered into | the cerebral spinal fluid or epidural area of the spine that corresponds with the area being treated |
| Spinals are generally used for procedures below the | waist. |
| Epidural catheters are often placed to facilitate | administration of medication into the spinal region |
| Moderate /Conscious/ Sedation | type of sedation that can be provided by a surgeon or staff while surgeon is performing a procedure. Provides a decreased level of consciousness that doesn't put the pt completely to sleep. |
| Moderate/Conscious/Sedation allow the patient to _______ without assistance and to respond to stimulation and ____ commands. | allows patient to breath without assistance and to respons to stimulation and verbal commands |
| A trained _________ must be present when _______ sedation services are provided by the same physician performing the therapeutic or dx service in order to assist the physician in _____ the _____ | trained /observer/ must be present when moderate sedation are provided to assist the physician in/monitoring/ the /pt/ |
| The codes to report conscious sedation are located in the | Medicine Section 99151-99157 not in the anesthesia section |
| Codes ______ report the moderate sedation services when the service is provided by the same physician performing the dx jor therapeutic serivice and requires the presence of an | 99151-99153 independent trained observer. The codes are divided based ont the pts age of under or over 5 yrs of age and the duration of the service. |
| Codes _____ report moderate sedation services when the anesthesia service is provided by a | 99155-99157physician other than the health care professional performing the service. |
| Bundled into 99155-99157 is the | assessment of the pt, establishment of intravenous access, administration of the sedation agent, sedation maintenance, monitoring of pt vital signs, and recovery from the anesthesia. |
| The code descriptions for the Moderate/Conscious/ Sedation codes include the term | intraservice time begins with the administration of the sedation agent requires continuous face to face attendance by the physician and ends when the personal contact by the physician ends. |
| The time the physician spends with the pt in assessment of the pt prior to administration of the sedation and the time in recovery is not | included in the intraservice time |
| Moderate or conscious sedation methods are much less invasive than anesthesia services that provide the | complete loss of conciousness |
| Most anesthesia codes are divided first by | anatomic site first then by specific type of procedure |
| The last four subsections in anesthesia Rad procedures 01916-01942 Burn Excisions or debridement 01951-01953 Obstetric 01958-01969 and Other Procedures 01990-01999 aren't | organized by anatomic division. The CPT codes in the Radiologic Procedures subsection report anesthesia service when radiologic services are provided to the pt for dx or theraputic reasons. |
| Example CPT 01925 Therapeutic reason: | Anesthesia for therapeutic interventional radiological procedures involving the arterial system; carotid and coronary |
| Example CPT 01922 Diagnostic Reason | Anesthesia for noninvasive imaging or radiation therapy. |
| Anesthesia Providers may be a/n | Anesthesiologist, Certified registered nurse anesthetist CRNA, Anesthesiologist's assistant who can't work w/o oversigt of anesthesiologist Resident can't bill if the case is performed w/o the particpation of anesthesia provider, Student registered nurse |
| Student Registered nurse anesthetist billing is based | on specific rules for each payor depending on the payer's definition of medical direction. |
| Anesthesia providers | Anesthesiologist, Certified registered nurse anesthetist CRNA, Anesthesiologists assistant, Resident, Student registered nurse anesthetist |
| Anesthesiologists assistant | may not work without oversight of anesthesiologist |
| Resident cannot bill | if the case is performed without the participation of another anesthesia provier |
| Student Registers nurse anesthetist billing is base on | specific rules for each payer depending on the payer's definiton of medical direction |
| When an anesthesiologist provides an anesthesia service to a pt the preoperative intraoperative and postop care are | all included in the CPT code. |
| AA HCPCS modifier | Anesthesia services performed personally by an anesthesiologis |
| AD HCPCS Modifier | Medical supervision by a physician more than four concurrent anesthesia procedures |
| G8 HCPCS Modifier | Monitored anesthesia car MAC for deep complex, complicated or markedly invasive surgical procedure |
| G9 HCPCS Modifier | Monitored anesthesia care for patient who has a history of severe cardiopulmonary condition |
| QK HCPCS Modifier | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals |
| QS HCPCS Modifier | Monitored anesthesia care service |
| QX HCPCS Modifier | Certified registered nurse anesthetist CRNA service, with medical direction by a physician |
| QY HCPCS Modifier | Medical direction of one certified registered nurse anesthetist CRNA by an anesthesiologist |
| QZ HCPCS Modifier | CRNA Service, without medical direction by a physician |
| Anesthesia Modifiers are always placed first after the | CPT anesthesia code. These anesthesia modifiers are pricing modifiers and are listed first to ensure correct reimbursement. |
| Some third party payers require additional modifiers to indicate how many | cases an anesthesiologist was performing or directing at one time |
| Certified registered nurese anesthetists CRNAs may administer anesthesia to patients under | the direction of a licensed physician or they may work independently. |
| An anesthesiologist may medically direct up to | four cases at the same time consurrently. |
| If a physician directs more than four cases it is referred to as | medical supervision |
| Medical direction means | the directing anesthesiologist is present at the induction and emegence from anesthesia for all key portions of the procedure and is immediately avail in case of emergency The CRNA would be with the pt the entire time |
| The CRNA would be with the patient the entire time during | Medical direction |
| CMS Rules When medical direction occurs certain documentation must be submitted supporting that certain services were performed by the physician these include | Preanesthesia exam and eval, Prescription of an anesthesia plan, Personally participates in most demanding procedures, Ensures are performed by a qualified anesthestist Monitors anesthes admin at freq intervals remains physically present provides post a |
| Anesthesia formula for billing is | (Base Units + Time Units+ Modifying Units) X conversion factor |
| Another tool is the ASA CROSSWALK book from the | American Society of Anesthesiologits and it provides anesthesia coders with a comprehensive list of CPT codes that link to the corresponding anesthesia code/s |
| CPT codes are located in the crosswalk book enabling the anesthesia coder to select the service with the | highest base value for submission. The book also lists alternative codes allowing the anesthesia coder to make the most specific selection |
| The anesthesia crosswalk book is updated bly | the ASA annually |
| The ASA publishes a Relative Value Guide RVG which contains | codes for anesthesia services and the base unit value for each anesthesia code. |
| The CPT manual also contains these anesthesia service codes in the | Anesthesia section |
| Italicized comments appear in the | American Society of anesthesiologists Relative Value Guide to clarify code assignment These italicized comments are not part of the CPT manual |
| Anesthesia is paid based on | Base Units +, Time Units+, Modifying Units (if allowed) X conversion factor |
| CMS Base Units The RVG is not a fee schedule (a list of charges for services) but instead compares anesthesia services | with each other. for example, anesthesia for a biopsy of a sinus are less complicated than services for radical sinus surgery |
| A team of physician with expertise in anesthesiology developed the comparisons and assigned numerical values to | each service, termed the base unit value |
| Annually CMS also publishes a list of the base unit values for the codes The CMS's base unit value is accepted as the | Standard in the United States for most third party payers. |
| Unique to anesthesia coding occurs when multiple surgical procedures are performed during the same session. in this case | only the procedure with the highest base unit value is assigned. Example if during same surg proced a clavic biopsy base unit 3 and rad matect base uni value 5 the base unit for both proced becomes 5 The anes serv is only reported for the higher base u |
| If multiple services are performed with different base units the Highest base unit is reported with only the code | ffor the higher base unit value Add on codes cannot be reported alone |
| Medicare anesthesia service involoving multiple procedures is reported with the CPT anesthesia code for the procedure with | the highest base unit value. The actual total time for all procedures is reported |
| Medicare only one anesthesia code can be reported . There is an exception for the add on codes for | burn excision or debridement 01953 and obstetric 01968, 01969 |
| The pricing for add on anesthesia codes is different from other payers because only the base unit value of the add on code is | allowed and all anesthesia time is reported with the anesthesia code. There isan exception to this rule when reporting obstetrical anesthesia. |
| Obstetrical anesthesia both the base unit and time units for the primary and add on obstetrical codes are | reported |
| Anesthesia services are provided base on the | time during which the anesthesia was adminstered and calculated, in total minutes. |
| The timing is started when the anesthesiologist | begins preparing the pt to receive anesthesia and is in constant attendance with the pt continues through the procedure, and ens when the pt is turned over to the postanesthesia caregivers |
| The minutes during which anesthesia was administered are | recorded in the patient record. Carriers independently determine the amt of time that is considered a unit |
| Often 15 minutes equal | one unit but for some carriers 1, 10, or 30, minutes equals one unit |
| P1 | a normal health pt (Base Unit Value 0) |
| P2 | A patient with mild systemic disease ( Base Unit Value 0) |
| P3 | A patient with severe systemic disease (Base Value 1) |
| P4 | A patient with sever systemic disease that is a constant threat to life (Base Value 2) |
| P5 | A moribund patient who is not expected to survive without the operation (Base Unit Value 3) |
| P6 | A declared brain dead patient whose organs are being removed for donor purposes (Base Unit Value 0) |
| The physical Status modifier is not assigned by the coder but is determined by the | anesthesiologist and documented in the anesthesia record. |
| The physical status modifier begins with the letter P and contains a number from | 1-6 Note that the relative value for P1 P2 P6 are zero because these conditions are considered not to affect the service provided. |
| A Physical Status Modifier is used after | the five digit CPT code |
| B-Base Procedure Value/the actual procedure being done T-The total Time of anesthesia Service , Modifiers/P Physical Status Modifiers extreme age Add up for the total | Add up for units . The CPT code will be first, then the total units Example 00400 P3 99100 9 |
| 00400-P3 Anesthesia for procedure of integumentary system of knee for a pt with severe systemic disease /severe hypertension | 99100 Anethesia for an 84 yr old pt, 9 units at the third party payer established rate of 15 min per units 60 minutes |
| example 3 base procedure value 4 time units 2modifiers physical tatus =1 : estreme age =1 total units 9 | 00400 P3 -a pt with sever systemic disease base unit value1 99100 Anesthesia for 84 yr old 9 units |
| Conversion Factor is | the dollar value of each unit Each third party payer issues a list of conversion factors. The list may vary with geographic location because the cost of practicing medicine varies from one geographic region to another. |
| The conversion factor for the locale geographic location is multiplied by the | number of units for the procedure so in previous example there were 9 units NY is $22.87 per unit 9x 22.87 =$205.83 the total for the procedure North Dakota is $19.47 per unit $175.23 ttl |
| Multiple Procedures-when multiple surgical procedures are performed during | a single anesthetic administration, the anesthesia code that represents the highest base value unit procedure is reported. The time reported is the combined total for all procedures |
| Multiple Procedures- The time reported is the | combined total for all procedures. |
| Multiple Procedures- Assign the code for procedure of | highest base value unit |
| Multiple Procdures- Indicate cumulative start/stop time for all surgical | surgical procedures performed |
| Multiple Procedures- Anesthesia time for a medically necessary surgical procedure performed during the same intra-operative | session as a cosmetic procedure should be split and reported separately |
| Medicare Rules modifier-50 would not be used on anesthesia CPT codes. It would be used on | anesthesia surgical procedures performed by anesthesiolgoists, such as femoral continuous block for pain management for bilateral knee replacement64448-59-50 |
| Modifier -50 example used on anesthesia surgical procedures performed by anesthesiolgist such as femoral continuous | blocks for pain management for bilateral knee replacement 64448-59-50 in addition to the ASA code or anesthesia CPT code |
| When used the Qualifying Circumstances code is reported in addition to the | Primary anesthesia procedure code |
| Example if anesthesia was provided for 80 yr old pt during a corrective lens procedure the reporting would be | 00142 Anesthesia for procedures on eye, lens surgery 99100 Anesthesia for 80 yr old ptpecial Circumstances |
| The RVG lists the Qualifying Circumstances codes along with the | relative value for each code |
| The CPT Index lists the Qualifying Circumstances codes under | Anesthesia, Special Circumstances |
| A Qualifying Circumstances code is reported in addition to the anesthesia procedure code. Qualifying Circumstances codes are | located in two places in the CPT manual the Medicine section and the Anesthesia section Guidelines both the +symbol 99100-99140 |
| Qualifying Circumstance begin w 99 when anesthesia is administered in situations that make the administration of the | anesthesia more difficult such as ER situations, Extreme age,services performed w hypotension or ttl body hypothermia |
| Medicare time units are computed by dividing the actual anesthesia service time by 15min and rounding to 1 decimal plac | No time units are reported for anesthesia CPT codes 01953-01996. |
| Medicare reimburses for anesthesia services base on a combination of | time and base units multiplied by a geographic area specific conversion factor |
| The start time on the anesthesia records should match the time reported on the | claim form. The recorded time on all records must be the same: Anesthesia record CRNA/anesthesiolog, or resident billing slip |
| The start time on the anesthesia records should match the time reported on all claims on all records must be the same | Time on all documents submitted to insurance company |
| Always record the actual time that indicates the ending | time of personal attendance |
| The stop time is when | the patient can be safely turned over to a non-anesthesia provider. This generally does not occur in the operating room |
| The Start time on the anesthesia record should match the time reported on the claim form and indicate the | beginning time of the service |
| Modifying Units Reflect circumstances or conditions that change or modify the environment in which the | anesthesia service is provided. There are two base modifying factors qualifying circumstances codes and physical status modifiers. |
| A Swan-Ganz catheter is nota a normal service provided during a surgery so it could be reported unsing a code from the | Medicine Section for placement of a flow-directed catheter 93503 some payers require modifier -59 if another cent line is placed |
| Swan-Ganz catheter the time necessary to insert the catheter is not counted in the anesthesia time because the | service of the insertion is reported separately and is considered a surgical procedure |
| Swan-Ganz reporting the insertion separately and also adding the insetrion time to the anesthesia service would result | in double payment for the insertion service. |
| Included Pre op, Intra op, and post op care included in CPT code | usual pre op post op visits on day of surgery routine intra op care such as admin of fluids and/or blood usual monitoring services |
| Inclused pts history ventialtion establishment and admin of preop and post op meds Monitoring services blood pressure | temp, aterial oxygen levels oximetry, exhal of carbo dioxide/capnography, and spectrometry blood analysis |
| Included intra op intubation to admins anesthesia Post op includes pain management some pain management is | reported separately like spinal injection for signif post op pain |
| If the anesthesiologist provides care that is unusual or beyond that which would usually be provided these services can be | reported in addition to the basic anesthesia service for exam if pt requires intra op cardiac monitoring the anesth may insert a swan Ganz catheter |
| do not confuse conscious sedation with monitored anesthesica care. Conscious sedation is admistered by the | surgeon or another physician; MAC is provided by an anesthesiologist or CRNA |
| Unlisted Anesthesia Code located under the other procedures subsection in the anesthesia section | when ther is no CPT code to indicate the anesthesia service the unlisted 01999 anesthesia code may be reported. |
| Return to Operating Room on the same day for the same or a related procedure the same indiv is performing the 2nd | procedure report the service with modifier -76 example 00731 -AA 00811 AA-76 if performd by someone else AA-77 |
| Preanesthetic Examination if the exam was provided by an anesthesiologist for a pt who did not undergo surgery | the E/M service would be reported for consideration for reimbursement |
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