Transcript The Complete Procedure Coding Book By Shelley C. Safian

The
Complete Procedure
Coding Book
By
Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
Chapter 6
Anesthesia Coding
McGraw Hill/Irwin
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved
6-2
Learning Outcomes
• Correctly apply the guidelines for
proper anesthesia coding.
• Interpret the types of anesthesia
as they relate to the coding
process.
• Select the best, most appropriate
code for anesthesia services.
6-3
Learning Outcomes
• Abstract the notes to determine
the correct physical status
modifier.
• Correctly apply qualifying
circumstances add-on codes.
• Properly use HCPCS Level II
modifiers.
6-4
Introduction
•
The procedure codes for
reporting the administration of
anesthetics are in the second
section of CPT.
•
Codes 00100-01999 and codes
99100 - 99140 from the medicine
section
6-5
Types of Anesthesia
• Topical and/or Local
• Regional
• General
• Moderate (conscious) sedation
• Monitored Anesthesia Care
(MAC)
6-6
Coding Anesthesia
• Confirm who administered the
anesthetic.
– Physician also doing the procedure
– Another physician
• Identify anatomical site upon
which the procedure is being
performed that requires the
patient to be anesthetized.
6-7
Coding Anesthesia
• Confirm the exact procedure
performed, as documented in
the physician’s notes.
• Consult the CPT book alphabetic index.
• Go to the numeric portion of
CPT to confirm the code.
6-8
Coding Anesthesia
• When the same physician
performing the procedure is the
one administering regional or
general anesthesia, DO NOT use a
code from the anesthesia section.
• Use modifier 47 Anesthesia by
Surgeon, which is appended to
the code for that procedure.
6-9
Coding Anesthesia
• Surgical procedure codes already
include topical, local, and digital
block anesthesia.
• Do not code these separately from
the anesthesia section.
• Moderate (conscious) sedation is
coded from the Medicine section.
6 - 10
Anesthesia Guidelines
Anesthesia codes already include:
• Usual pre-operative visits.
• Anesthesia care during the
procedure.
• Administration of fluids.
• Usual monitoring services.
• Usual post-operative visits.
6 - 11
Anesthesia Guidelines
When multiple procedures
are performed during the
same operative session, the
anesthesia should be coded
for the most complicated
procedure only.
6 - 12
Time Reporting
• Clock starts when the
anesthesiologist start to
prepare the patient for
administration of anesthetic
• Measured in 15-minute
increments
• Clock stops when patient is in
post-operative area
6 - 13
Time Reporting
• (B + T +M) * CF
• B = base unit (assigned by the
American Society of Anesthesiologists)
• T = time spent
• M = modifying factor
• CF = conversion factor to turn
units into dollars
6 - 14
Qualifying Circumstances
•
•
•
•
99100 Patient of extreme age
99116 Total body hypothermia
99135 Controlled hypotension
99140 Emergency conditions
6 - 15
Conscious Sedation
• Also called Moderate Sedation
• Administered by same
physician performing the
procedure, use codes 99143 99145
6 - 16
Conscious Sedation
Administered by another
physician, use codes 99148 99150 unless…Location is
physician’s office or
freestanding imaging center,
conscious sedation is not
separately reported
6 - 17
Conscious Sedation
• Administered by another
physician
• And the procedure is NOT
LISTED in Appendix G
• Code conscious sedation from
the anesthesia section 00100 01999
6 - 18
Conscious Sedation
• Procedure codes listed in
Appendix G have a bull’s eye
symbol  next to the code in
the numeric listing
• These codes include conscious
sedation - do not code it
separately
6 - 19
Anesthesia Modifiers
• 23 Unusual Anesthesia
• 47 Anesthesia by Surgeon
• Do NOT append to an
anesthesia code but to the
code for the procedure
6 - 20
Anesthesia Modifiers
Physical Status Modifiers
• P1 Normal healthy patient
• P2 Mild systemic disease
• P3 Severe systemic disease
• P4 Systemic disease is threat to life
• P5 Moribund patient
• P6 Brain-dead patient
6 - 21
Anesthesia Modifiers
Physical Status Modifiers
• Appended to ALL anesthesia
codes
• NEVER appended to any other
types of codes
6 - 22
Anesthesia Modifiers
HCPCS Level II Modifiers
• AA Anesthesiologist
• AD Medical supervision of more
than 4 concurrent procedures
• G8 Monitored Anesthesia Care
(MAC) complex procedure
• G9 MAC for patient with severe
cardiopulmonary condition
6 - 23
Anesthesia Modifiers
HCPCS Level II Modifiers
• QK Medical direction of 2, 3, or 4
concurrent procedures
• QS MAC
• QY Medical direction of CRNA
• QX CRNA service under supervision
• QZ CRNA service without
supervision
6 - 24
Chapter Summary
•
Code for reporting services to
patients in need of an anesthetic,
no matter who had administered
it or why.
•
These factors are critical to
obtaining proper reimbursement.