Hello, this is Cindy. Today we're going to
talk about the Anesthesia chapter which
is Chapter 9 in your CPT textbook. Some
general information first of all. These
codes are used to report services by the
physician or a certified registered
nurse anesthetist (that's hard to say) or
CRNA who provides or supervises the
anesthesia. Codes in this section are
arranged first by body site and then
by the specific surgical procedure
performed except for those at the end of this
chapter which have to do with Radiology
procedures and Other procedures. You'll
notice as you look through the chapter
that several procedures can be assigned
to one anesthesia code. Main terms are
going to be either anesthesia or
analgesia. Like many codes, third-party
payer guidelines have to be considered
before you submit these codes for
payment because they have all kinds of
rules and regulations around them.
Anesthesia service includes pre and
post-operative visits, the anesthesia
itself provided during the procedure, the
administration of fluids and blood and
the usual services like what the anesthesiologist
monitors are EKG, temperature,
blood pressure, oximetry, capnography and
mass spectrometry. The unusual monitoring
that could happen that would be reported
separately would be any kind of
monitoring of the heart's function or
blood flow using an intra-arterial, a
central venous line or a Swan-Ganz
catheter. So some things to keep in mind.
If you're coding for an anesthesiology
practice, this is probably all you're doing,
coding for anesthesia and you're
going to be very good at knowing what
you will and will not report and you are also going to
know your payer guidelines inside out.
That's the beauty of coding for a
practice that uses these smaller
chapters. You can really know all the
codes and all the rules and regulations
around them. The types of anesthesia are
local, regional, general and what we
refer to as "conscious sedation". They
are very different. The only types of
anesthesia that are covered in this chapter
are the local, regional and general.
The conscious sedation is covered in the
Medicine chapter. The difference is with
conscious sedation, you are able to
breathe independently, maintain your
airway, respond to verbal commands. You
really aren't knocked out, so to speak.
When you have general anesthesia, you're
going to be completely unconscious and
you're going to be probably on a
ventilator and that's going to take care
of your airway. A regional anesthesia is
like a block, a nerve block. When
I had my knee replaced, I had a spinal
block and I had a regional or a femoral
blocks on the affected leg. So it
depends on how the other doctors and
anesthesiologist want to administer the
sedation. Local, of course, would be
when you get a little numbing shot when
you have stitches put in or something like
that. Some carriers require that time be
included on a claim and counting
anesthesia time should begin with the
preparation of the patient by the
anesthesiologist for the induction of
anesthesia, usually in the OR (operating room) when that
happens and time ends when the
anesthesiologist is no longer in attendance.
Anesthesia has what's called "Physical
status modifiers" and you will often see these
reported with the anesthesia code and
here they are. They are in the front
inside cover of your CPT code book so
you don't have to memorize them but you
do need to understand what they mean and
you also need to understand when to use
them. That would be when you are
assigning an anesthesia code, automatically
think about your physical status
modifiers. There are other modifiers that
anesthesia could use and they've got
them reproduced here on this slide. You
may see them, for example number 22, say
you are administering anesthesia some some kind of
cardiac procedure and once you get in
there, it just takes the surgeon longer
than it normally would, so the
anesthesiologist, therefore, has to be
there longer so the anesthesiologist
would append a -22 modifier to the
anesthesia code. Modifier - 23 Unusual anesthesia
might be if you typically don't have
anesthesia but because you're dealing
with a patient who is, let's say severely
mentally disabled or intellectually
challenged and just can't understand
what you want to do and why you want to
do it, you may have to administer
anesthesia. So that would use a -23
modifier. Then you see the other ones
there. -53 is used if the physician elects
to terminate a procedure because it's
just not healthy to go forward. That's
different than the patient saying no,
I don't want it. That is a different
modifier. You're never going to use
modifier -47 Anesthesia by Surgeon for
the anesthesia procedures. I never
use that modifier so I'm not really sure
when you would need it but it's
obviously there for someone to use if
they need it. More general information
that we need to remember. Those HCPCS
level 2 modifiers are in your textbook.
You are not responsible for those in HIT241.
There's a lot of things there that I
think you would only use them in very
specific circumstances. So you're not
responsible for that in this course.
There were some CPT codes discussed in
the Medicine chapter that were called
"Qualifying circumstances for anesthesia".
These are never used alone and always
reported with the anesthesia CPT codes.
We will be looking at few of those in a few
moments. An anesthesia code would not be
reported by the hospital unless the
hospital is performing the billing
services for the anesthesiologist. So
really the only people using these
anesthesia codes are those who are
billing for the anesthesiologist. OK,
let's look at some of the Review
questions in your CPT textbook. I follow
the usual format where I give you the
scenario and you attempt to find a code
and then we'll be looking at the answers
in the next slide. These anesthesia
services for a cervical cerclage where
the patient is 25 years old in good
health. This is typically done when, let's
say a patient is
pregnant and the cervix wants to dilate
and the baby is not ready for delivery.
The doctors will go in and actually sew
the cervix together. This is the anesthesia
service for that procedure. Don't
forget the physical status modifiers.
Your main term is "Anesthesia, cervix"
and then there's your code. We would use
a P1 physical status modifier because it
is a healthy patient so it's a
"normal" patient. (Chapter 9 Review #4) Anesthesia
services for an open repair for a malunion
fracture of the humerus. Patient is 85
years old and healthy. Two additional
things are needed- your physical status
modifier which is going to be P1 because
this person is healthy, then the CPT code
for qualifying circumstance because this
is a person of extreme age. Here would
be the pathway and the codes that you would
assign. I'm not sure why this particular
code is for anesthesia for open or
surgical excision of the elbow;
repair of non-union or malunion of the
humerus and not quite sure why the
elbow's thrown in there but that's howt
it's written. The repair of a
malunion of the humerus is right on with
what our scenario asked for, so we would use
this code.
#6. Anesthesia services for a
partial nephrectomy and a patient with
renal cell carcinoma, 45 year old patient,
also has mild coronary artery disease
and hypertension treated with medication.
Don't forget the physical status
modifier. Ok, it's a patient who's young
so you're not going to have
any kind of qualifying circumstance for
extreme age but the patient does have
mild coronary artery disease and
hypertension so that's going to give he
or she a P2 Physical Status modifier,
which would be assigned along with your
anesthesia. There is your code.
Anesthesia services for a
blepharoplasty which is a repair of the
eyelid. Patient is in good health.Don't
forget your physical status modifier.
Well, because the person's in good health
you know there's a P1 modifier and when
you look up the code, it is anesthesia for
eyelid. Now if you didn't know that
blepharo- was the prefix meaning the
eyelid, you would have to search for
medical terminology, either on your
Google search engine or in a medical
terminology book there on your desk,
however you would look that up. I really
cannot overemphasize the importance of knowing
your anatomy and physiology and keeping
those textbooks handy. You will learn and
remember many more things as you code if
you code for a living but you will
always find words that you don't know so
that's where the Google search engines
are very, very helpful i. If you don't
recall a hint I had earlier in the
semester, if you open your browser and in
the address bar, put the term that you
want to search for and then a colon (:) that
colon is the message to Google that you
want a definition and it will search for
that definition and show you some hits
when you open up your search page.
I use it probably at least
twice a day looking up terms, medical
terms that I'm not familiar with.
#10 is anesthesia for a left
lobectomy due to a lung carcinoma.
You remember from your medical
terminology, your anatomy and physiology,
a lobectomy would be the removal of one of the
lobes of a lung. The lung has more than
one lobe. Patient also has severe chronic
obstructive pulmonary disease and
emphysema treated with bronchodilators.
Now this time the patient has severe
disease so that's probably going to be a
P3 physical status modifier along
with your anesthesia code. Remember that
the physical status modifiers are
located on the inside cover of your CPT
code book. If you have any questions about
Chapter 9, please use the discussion
board to post those questions. If you're
asking about a specific exercise, please
post the path you used to try and find the
code. We will not spend much time on this
chapter and there will not be very many
questions on the exam but I just want
you to be aware of it so that you would
know to always use those physical status
modifiers and keep in mind qualifying
circumstances. That's all I have for Chapter 9.
Have a good day.
you