chapter 61 anesthesia part ii: coding procedures part ii:

Chapter 6 1

AnesthesiaAnesthesia

Chapter 6

CODING PROCEDURES Part II:Part II:

Chapter 6 2

Anesthesia is the administration of a drug or other anesthetic agent by injection injection or inhalationinhalation to obtain muscular muscular relaxation, loss of sensation and/or relaxation, loss of sensation and/or loss of consciousness.loss of consciousness.

Anesthesia is classified according to the effect they have on the body.

Coding Procedures & Services Anesthesia SectionAnesthesia Section

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 3

Anesthesia Classification/Types Types & & Examples:Examples:

Topical/Gel Gel applied to the urethra for dilationapplied to the urethra for dilation IncludedIncluded in surgical procedure (can not bill

separately)

Local/ SubcutaneousSubcutaneous injection injection to remove a to remove a nervenerve

IncludedIncluded in surgical procedure (can not bill separately)


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 4

Anesthesia Classification/Types Types & Examples:& Examples: Cont.Cont.

Regional/EpiduralEpidural delivery injection used during labor delivery injection used during labor & delivery& delivery

NotNot Included in surgical procedure (can bill separately)

General/Inhalation Inhalation of a substance during tonsillectomy of a substance during tonsillectomy to render the patient totally unconsciousto render the patient totally unconscious

NotNot Included in surgical procedure (can bill separately)


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 5

ArrangementAnatomic Site where the Surgery is performed

Anesthesia SubsectionsDivided by Anatomic Site, , except:

Radiological Procedures - Radiological Procedures - subsection is used when subsection is used when anesthesia anesthesia is providedis provided during a diagnostic or therapeutic radiologic service. during a diagnostic or therapeutic radiologic service. Burn Excisions Burn Excisions or Debridement & Other Procedures Other Procedures - - The The Burn section Burn section is arranged according to percent of body surface area treated and used when surgery is performed to debride and/or clean a burn.


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 6

Research Anesthesia Codes by: WhereWhere - surgery was performed (anatomic

site) What - What - type of anesthesia administered Who - Who - provided the anesthesia

(anesthesiologist, physician, etc)


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Chapter 6 7


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

01462

To Find Anesthesia Code:

Bunionectomy

Index/Anesthesia/Foot (anatomic part)

Chapter 6 8

Anesthesia ModifiersAnesthesia Modifiers must be used with anesthesia procedure codes to indicate whether the procedure was:

Personally performed,Personally performed, Medical directedMedical directed or Medically supervised.Medically supervised.

Coding Procedures & Services Anesthesia Section/Anesthesia Section/ModifiersModifiers

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 9

AA AA - - Anesthesia services personally performed by anesthesiologist. ADAD – Medical supervised by a physician QK QK – Medical direction of two, to four concurrent anesthesia procedures involving qualified individuals QSQS – Monitored anesthesia care QX QX – CRNA service (Certified Registered Nurse Anesthetist) QYQY – Medical direction of one CRNA by a physician QZ QZ – CRNA service; without medical direction by a physician

Coding Procedures & Services Anesthesia Section/Anesthesia Section/ModifiersModifiers

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 10

The Physical StatusPhysical Status is the condition of the patient at the time anesthesia was administered.

An AnesthesiologistAnesthesiologist determines the physical statusphysical status of a patient & document the information in the Anesthesia record.

The Physical Status ModifierPhysical Status Modifier are located in the Anesthesia Guidelines.

Coding Procedures & Services Anesthesia Section/Anesthesia Section/PhysicalPhysical Status ModifiersStatus Modifiers

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 11

Modifiers-47-47 (anesthesia by surgeon)

P1-P6P1-P6 (Physical Status Modifiers)P1 P1 A normal healthy patientP2P2 A patient with mild systemic diseaseP3P3 A patient with severe systemic diseaseP4 P4 A patient with severe systemic disease that is a constant threat to lifeP5 P5 A moribund patient who is not expected to survive without the operationP6P6 A declared brain-dead patient whose organs are being

removed for donor purposes.


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Chapter 6 12

ASA (American Society of Anesthesiologists ) allows other medical modifiers to be used in anesthesia which include:

-22 – unusual services; -23 – unusual anesthesia; -25 – significant, separately identifiable

evaluation and management service by by the same physician on the same day the same physician on the same day of the procedure or other service; of the procedure or other service;

-59 – distinct procedural service.


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

http://www.asahq.org/

http://www.asahq.org/

Chapter 6 13

Qualifying Circumstances (99100-99140)/(99100-99140)/Medicine SectionMedicine Section Located in the Anesthesia Guidelines Identified by + symbol as an “add-on-code”.

Coding Procedures & Services

Anesthesia Section/ Section/Anesthesia Section/ Section/Qualifying CircumstancesQualifying Circumstances (00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 14

Coding Procedures & Services Anesthesia Section/Anesthesia Section/BillingBilling InformationInformation

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

All ANESTHESIA VALUES are determined by taking the BASIC UNIT VALUE (which is related to the complexity of the service,) and;

TIME UNITS; plus MODIFYING UNITS (if any),

The Fee/Payment Fee/Payment for a particular procedureprocedure or serviceservice in the Anesthesia Section is determined by multiplying the listed "Basic Unit Value""Basic Unit Value" by the Conversion FactorConversion Factor that is applicable to the section.

Chapter 6 15

Basic Unit Value

Is the basis for determining the base points is the Relative Value Guide published by the American American Society of Society of Anesthesiologists Anesthesiologists (ASA).(ASA).

Anesthesia Payment & Billing Information

http://tx.dev.hcsctest.net/provider/gri/anesthesia_options.htm


Chapter 6 16

Anesthesia Payment & Billing Information

Time Units Time UnitsTime Units will be determined by using the total time in minutes actually spent performing the procedure.

Fifteen MinutesFifteen Minutes is equivalent to one (1) time unit.

Time UnitsTime Units will be rounded to the tenth. Therefore, if the procedure lasted 49 minutes, the time units in this example would be 3.26 or 3.3 time units. (i.e., 49/15=3.26 (i.e., 49/15=3.26 or 3.3)or 3.3)



Chapter 6 17

Anesthesia Payment & Billing InformationUnit

Value(s)

Physical Status Modifiers – to be billed by AnesthesiologistsAnesthesiologists and/or CRNAsCRNAs

P1 P1 A normal healthy person 0

P2 P2 A patient with mild systemic disease 0

P3 P3 A patient with severe systemic disease 1

P4P4A patient with severe systemic disease that is a constant threat to life 2

P5P5

A moribund patient who is not

expected to survive without the

operation 3

P6 P6

A declared brain dead patient whose organs are being removed for donor purposes

0



Chapter 6 18

Anesthesia Payment & Billing Information Unit Unit Value(s)Value(s)

Qualifying Circumstances to be billed by AnesthesiologistsAnesthesiologists and/or CRNAsCRNAs

+99100+99100

Anesthesia for patients of extreme age, under 1 year and over 70 (list separately in addition to code for primary procedure) 1

+99116+99116

Anesthesia complicated by utilization of total bodytotal body hypothermia (list separately in addition to code for primary procedure) 5

+99135+99135

Anesthesia complicated by utilization of controlled controlled hypotensionhypotension (list separately in additional to code for primary procedure) 5

+99140+99140

Anesthesia complicated by emergency conditionsemergency conditions (specify) (list separately in addition to code for primary procedure)

2



Chapter 6 19

Coding Procedures & Services Anesthesia SectionAnesthesia Section/CalculatingCalculating Anesthesia TimeAnesthesia Time

(00100-01999, 99100-99140(00100-01999, 99100-99140

Base Units Base Unit Values have been assigned to

each anesthesia procedure code and reflect the difficulty of the anesthesia service, including the usual pre-operative and post-operative care and evaluation.

Time Units Time units is the time during which an

anesthesia practitioner is present with the patient

Conversion Factor – is the allowed amount assigned to the “Base Unit”.

Chapter 6 20


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

All anesthesia values are determined by taking the BASIC UNIT VALUE, which is related to the complexity of the service, and adding MODIFYING UNITS (if any), and TIME UNITS.

The Fee for a particular procedure or service is determined by multiplying the listed "Basic Unit "Basic Unit Value"Value" by the Conversion FactorConversion Factor BaseBase = base units per anesthesia CPT coded. Obtained from the Obtained from the American Society of Anesthesiologists (ASA) 1988 American Society of Anesthesiologists (ASA) 1988 Relative Value GuideRelative Value Guide

FORMULA:FORMULA:((Base UnitsBase Units + + Times Units+ Modifying UnitsTimes Units+ Modifying Units) x ) x Conversion FactorConversion Factor = =

AllowanceAllowance

Chapter 6 21

Coding Procedures & Services Anesthesia SectionAnesthesia Section/CalculatingCalculating Anesthesia Anesthesia

TimeTime (00100-01999, 99100-99140)(00100-01999, 99100-99140)

Anesthesia time is the time during which an anesthesia practitioner is present with the patient.

Time units are determined on the basis of one one time unit for eachtime unit for each 15 minutes of anesthesia.15 minutes of anesthesia.

Time Units Round-upRound-up if five or more Round-downRound-down if four or less

Calculating Anesthesia TimeCalculating Anesthesia Time

Chapter 6 22

Example A Example A (Round-down):(Round-down):

Total anesthesia time = 95 minutes/15 = 6.3.95 minutes/15 = 6.3. 95/3 = 6.395/3 = 6.3

Total time units claimed = 66

Example B Example B (Round-up):(Round-up): Total anesthesia time = 70 minutes/15 = 70 minutes/15 =

4.6.4.6. 70/15 = 4.670/15 = 4.6 Total time units claimed = 55

Coding Procedures & Services Anesthesia SectionAnesthesia Section/CalculatingCalculating Anesthesia Anesthesia

TimeTime (00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 23

CALCULATION EXAMPLES:CALCULATION EXAMPLES: EXAMPLE 1:EXAMPLE 1: In a procedure with a Basic Unit ValueBasic Unit Value of 3.0 of 3.0

requiring requiring one hourone hour and and forty-fiveforty-five minutes of anesthesia time, minutes of anesthesia time, the total value should be determined as follows:


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Basic Unit Value = 3.0 units (ASA) 105 minutes÷15 minutes = 7.0 units (60+45=105) Total value = 10.0 units

Total Units * Conversion Factor = Maximum Allowable Fee

Example 1Example 1 – 10 Total Units ** $48.75$48.75 (conversion factorconversion factor) = $487.50 (max fee)

Chapter 6 24


(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 25

• EXAMPLE 2:EXAMPLE 2: In a procedure with a Basic Unit Basic Unit ValueValue of 10.0 requiring 10.0 requiring four hoursfour hours and and twenty twenty minutesminutes of anesthesia time of anesthesia time, the total value should be determined as follows:

Basic Unit ValueBasic Unit Value = 10.0 units (ASA)First four hour = 16.0 units

Subsequent 20 minutes = 4.0 units (10 Min. Increments)Total value = 30.0 units


Total Units * Conversion Factor = Maximum Allowable FeeExample 2Example 2 - - 30 Total Units ** $48.75$48.75 (conversion factorconversion factor)) =$1,462.50 (max fee)

Formula:Formula:(Base Units + Times Units+ Modifying Units) x Conversion Factor = Allowance - orAF=(BUxCF)+(CFxTU)+(CF xM)

Chapter 6 26


In both examples, the Maximum Allowable FeeMaximum Allowable Fee is determined by multiplying the multiplying the Total Value UnitsTotal Value Units by by the the Conversion Factor.Conversion Factor. The Basic Unit ValueThe Basic Unit Value (showing the procedure code and all

modifiers) and Time Units separatelyand Time Units separately, as in the following:

Procedure code + Modifier(s) = Basic Unit ValueAnesthesia Time = Time Units

Total value = Total units

Chapter 6 27


Procedure code + Modifier(s) = Basic Unit ValueProcedure code + Modifier(s) = Basic Unit Value

Procedure Code Basic Unit Value

00100 5+TM

Anesthesia Time = Anesthesia Time = Time UnitsTime Units

1 Hour 30 minutes = 6 Time Units

Total value = Total unitsTotal value = Total units

Basic Units = 5 + 6 Time units = 11 Total Units

Total Units x Conversion Factor = Maximum Allowable FeeMaximum Allowable Fee

Total Units = 11 x $48.70 = Conversion Factor = Total Units = 11 x $48.70 = Conversion Factor = $535.70$535.70 Max Max allowedallowed

Procedure code + Modifier(s) = Basic Unit ValueProcedure code + Modifier(s) = Basic Unit ValueAnesthesia Time = Anesthesia Time = Time UnitsTime Units

Total value = Total unitsTotal value = Total units

Chapter 6 28

Anesthesia Coding StepsAnesthesia Coding Steps

Step 1: Identify anesthesia procedure/service

Step 2: Assign physical status modifier

Step 3: Assign qualifying circumstance, if applicable

Step 4: Assign modifier codes, if applicable

Step 5: Calculate anesthesia time

Chapter 6 29

Applying the ConceptsApplying the Concepts

Identify the needed components for assigning anesthesia codes and appropriate modifiers in the procedure below:

Cornea Transplant

Chapter 6 30

Applying the Concepts

Step 1:Step 1: Identify anesthesia procedure/serviceprocedure/service Corneal transplant Subsection: HeadHead Anesthesia procedures on eyeeye: Corneal transplant

Code: 00144

Chapter 6 31


Step 2: Assign physical statusphysical status modifier No medical conditions listed, therefore

Physical status modifier = P1P1 Normal healthy patient with no risks

Step 3: Assign qualifying circumstancequalifying circumstance, if applicable No qualifying circumstances identified; No qualifying circumstances identified;

therefore, none assignedtherefore, none assigned

Chapter 6 32


Step 4: Assign modifier codes,modifier codes, if applicable

No extenuating circumstances identified No extenuating circumstances identified that require assignment of a modifier that require assignment of a modifier codecode

Chapter 6 33

Calculating Base Units

Anesthesiology Unit Values Rate is $37.02 per unit Rates for time based codes are calculated using base units plus time spent

CodeCode Base UnitsBase Units Max AllowedMax Allowed Total Time00144 6 6 1 Hr. 30 (90 min)

90/15 = 690/15 = 6//(Base unit only)(Base unit only)

Anesthesia’s time = 1hr 45 min = 7 Time Units7 Time Units

Total Units x Conversion Factor = Maximum Allowable FeeMaximum Allowable Fee

Total Base Units = 6Total Base Units = 6 + Total Time = 7Total Time = 7 = Total units = 11Total units = 11

Times $37.02 =Times $37.02 = $407.22 Maximum Allowed fee$407.22 Maximum Allowed fee

Chapter 6 34


Step 5: Calculate anesthesia time

Time not given; however, if procedure performed was 60 minutes,60 minutes, time calculation would be

10-minute increments – 6 time units 15-minute increments – 4 time units + Relative value units = Total units

Chapter 6 35

• Anesthesia for arthroscopic procedure of knee joint. • Conversion Unit = $ 49.95 • Basic Value = 3 • Time Units = 8 • Modifier = 0

1. What is the procedure cold?

2. What is the Anesthesia Fee?

Coding Procedures & Services Calculating Anesthesia Time/ Calculating Anesthesia Time/ ExampleExample

Procedure Code: 01382

Anesthesia Fee:Anesthesia Fee: $549.45

Anesthesia Fee = $549.45 (49.95 x 3)+(49.95 x 8)+(49.95 x 0)= $549.95 Formula:Formula: AF=(BUxCF)+(CFxTU)+(CF xM) or AF=(BUxCF)+(CFxTU)+(CF xM) or

AF = (BU+TU+M) x (CF)AF = (BU+TU+M) x (CF)

Chapter 6 36

Coding Procedures & Services

Anesthesia SectionAnesthesia Section (00100-01999, 99100-99140)(00100-01999, 99100-99140) PERFORMANCE EXERCISEPERFORMANCE EXERCISE

Anesthesia for open procedures involving upper 2/3 of femur, not otherwise specified

01230 Anesthesia for procedures on facial bones or skull;

not otherwise specified

00190

Breast Reconstrution, normal healthy patient

00402 & Modifier P1

Chapter 6 37

Billing Instructions CMS-1500 SubmissionCMS-1500 Submission

Item 24D – the appropriate anesthesia modifier. Must be reported.

Item 24G – the actual anesthesia time, in minutes, must be reported.

Coding Procedures & Services Anesthesia Section/ Section/Anesthesia Section/ Section/Billing InstructionsBilling Instructions

(00100-01999, 99100-99140)(00100-01999, 99100-99140)

Chapter 6 38

Anesthesia Salaries:

Salaried CRNA = 180,000*

Salaried MD = 300,000

Potential Profits with Salaried CRNA’s

Chapter 6 39

CRNA Recruitment OffersMar 9th, 2005

Robert Kelsey & Associateswww.rka100.com

ARKANSASCall 1 in 5

$170,000 7 wks. vacation

GEORGIA Call 6 per month

$200,000 ?

ILLINOIS Call 1 in 5 $200,000 ?

Chapter 6 40

Educational Differences

MD 4 yrs. College

4 yrs. Medical school

4 yrs. Residency

Fellowship?

CRNA 4 yrs. College

(1/3 practicing anesthetist w/undergraduate degree)

> 1 yr nursing experience

2-3 yrs nurse anesthetist training

Chapter 6 41

Certification Differences

MD Written test Oral exam Subspecialty exams

CRNA Written test

MD MD vs vs CRNA Recertification DifferencesCRNA Recertification Differences

MD10 yr recertification

(Jan 2000)

CRNA2 yr recertification

chapter 61 anesthesia part ii: coding procedures part ii:

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