ANESTHESIA

By: Naser C. Masilam, RN

INTRODUCTION

Anesthesia codes are grouped

beginning with the head.

anatomically,

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 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
mastectomy, but rather under BREAST.

Although, the liver is located in the upper

abdomen, the harvesting of a liver is reported
with code 01990 Physiological support for
harvesting of organ(s) from a brain dead patient,
which is listed under Other Procedures.

TYPES OF
ANESTHESIA
GENERAL ANESTHESIA

It is a drug
induced that can
loss consciousness.

TYPES OF
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

TYPES OF
ANESTHESIA
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 PROVIDERS
ANESTHESIOLOGIST
He is a physician to
practice medicine and
who is completed an
accredited anesthesiology
program.
Personally performed
Medically direct
Medically
supervised
members
of
an
anesthesia care team

ANESTHESIA
PROVIDERS
CERTIFIED REGISTERED
NURSE ANESTHETIST

(CRNA)
Completed 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
assistant training
program. May only be
medically directed by
an anesthesiologist.

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

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

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)

Unusual forms
arterial lines,
artery catheter
in the base unit

of monitoring for example,

central venous and pulmonary
(Swan Ganz) are not included
value of anesthesia codes.

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.

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 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.

PHYSICAL STATUS MODIFIER

P1 a normal healthy patient

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 whos organs are

being removed for donor purposes

QUALIFYING CIRCUMSTANCES

+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
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
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 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.

CPT MODIFIERS
Modifier 47 Anesthesia by Surgeon

It should not be appended to anesthesia codes

(00100-01999).

CPT MODIFIERS
Modifier 53 Discontinued Procedure
Describe

a procedure started and,

due to extenuating circumstances,
discontinued.

CPT MODIFIERS
Modifier 59 Distinct Procedural Service
This

modifier is often appended to

post pain operative management
services to indicate it is separate
from the anesthesia administered
during the surgery.

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

CPT MODIFIERS
Modifier 74 Discontinued OutPatient 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.

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

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

HCTCS LEVEL 2 MODIFIERS

AA anesthesia services performed personally by

anesthesiologist

AD medical supervision: more than 4 concurrent

anesthesia procedure

QA medical direction of 2,3 or 4 concurrent

anesthesia procedure involving individuals

QY medical direction of CRNA by an anesthesiologist

GC this service has been performed in part by a

resident under the direction of a teaching physician

HCTCS LEVEL 2 MODIFIERS

Most

anesthesia modifier are reported only

with anesthesia codes; they are not listed
with others CPT code categories.

THANK YOU
FOR LISTENING!!