1、2007 PMCCAnesthesiaChapter 18Chapter Outline Introduce students toForms of anesthesiaAnesthesia guidelines1.Anesthesia modifiers Anesthesia Guidelines Anesthesia service includes Usual preoperative and postoperative visits Administration of the anesthetic for the site of surgery Anesthesia care duri
2、ng the procedure Administration of fluids and/or blood replacement Interpretation of noninvasive monitoring(blood pressure,ECG,temperature,oximetry,apnography,and mass spectrometry)Time Key element for reimbursement Starts when anesthesiologist begins preparing patient in OR Ends when anesthesiologi
3、st no longer in personal attendance and patient is safely placed under postoperative supervisionAnesthesia Modifiers Three sets of modifiers to consider Physical status HCPCS CPT CPT manual also includes codes for Reporting circumstances that could increase the difficulty of providing anesthesiaPhys
4、ical Status Modifiers P1Normal,healthy patient P2Patient with mild systemic disease(eg,mild,benign,hypertensive heart disease)well controlled on medication P3Patient with severe systemic disease(eg,benign,hypertensive heart and renal disease with congestive heart and renal failure)P4Patient with sev
5、ere systemic disease that is a constant threat to life(eg,hypertrophic obstetric cardiomyopathy with ESRD)awaiting heart transplant P5 Moribund patient who is not expected to survive without surgery P6A declared brain dead patient whose organs are being removed for donor purposesCPT Modifiers 22Unus
6、ual Procedural Services 23Unusual Anesthesia(Identifies a procedure that usually requires no anesthesia or local anesthesia.Under unusual circumstances,general anesthesia is required)32Mandated Services 51Multiple Services 53Discontinued Procedure 59Distinct Procedural Service(Identifies certain cir
7、cumstances when a physician may need to indicate that a procedure/service was distinct or independent from other services performed on the same day)HCPCS Level II ModifiersAAAnesthesia service performed personally by anesthesiologistADMedical supervision by a physician:more than four concurrent anes
8、thesia proceduresG8Monitored anesthesia care(MAC)for deep complex,complicated,or markedly invasive surgical procedureG9Monitored anesthesia care for patient who has history of severe cardiopulmonary conditionQBPhysician providing service in a rural HPSAQKMedical direction of two,three,or four concur
9、rent anesthesia procedures involving qualified individualsQSMonitored anesthesia care service(MAC)QXCertified registered nurse anesthetist(CRNA)service,with medical direction by a physicianQYMedical direction of one certified registered nurse anesthetist(CRNA)by an anesthesiologistQZCRNA service,wit
10、hout medical direction by a physicianTypes of Anesthesia General Anesthesia Results in loss of consciousness Produces amnesia by blocking the awareness center in the brain CPT codes 00100-01999 represent general anesthesia unless code description states otherwise Regional Anesthesia Blocks all painf
11、ul sensation to the specific region of the body innervated by the nerve or nerve plexus receiving the anesthetic Does not induce unconsciousnessTypes of AnesthesiaPeripheral Nerve Blocks Anesthetize individual nerves or nerve plexuses Anesthetic agent injected along the nerve rather than in the nerv
12、e Codes 64400-64530 Used to describe these services Nerve Blocks Anesthetize entire regions Spinal Anesthesia Used for major procedures performed below level of the diaphragm Relatively safe Provides excellent muscle relaxation Accomplished by placing needle between the vertebrae and injecting anest
13、hetic agent into the subarachnoid space Frequently used for pain management by anesthesiologistsTypes of Anesthesia Epidural Anesthesia Achieved by injecting anesthetic agent into epidural space of thoracic or lumbar interspaces Usually avoid postoperative headaches Intravenous Regional Blocks Used
14、for some procedures on extremities Pneumatic tourniquet applied to the limb and anesthetic agent is injected into the vein of the limb distal to the tourniquet Field Block Used to form barrier between operative site and nervous system Accomplished by multiple injections of local anesthetic agent Loc
15、al Anesthesia Applied topically or by local infiltrationPain Management Benefits of proper pain management Shorter hospital stays Increased mobilization Acute Pain May be experienced during postoperative period Included in surgeons fee Should only be turned over to a specialist when special circumst
16、ances warrant this level of service Documentation must exist within medical record to indicate why services of anesthesiologist are neededPain Management Pain management options may include Cognitive,behavioral interventions such as education,relaxation,distraction,biofeedback Systemic administratio
17、n of a nonsteroidal anti-inflammatory drugs(NSAID)or opiates Patient controlled analgesia(PCA)Spinal analgesia Intermittent or continuous nerve block Physical agents(eg,massage)application of heat or cold modalities Transcutaneous electrical nerve stimulator(TENS)Chronic Pain Pain that does not reso
18、lve itself after 3-6 months Treated by variety of modalitiesMonitored Anesthesia Care(MAC)At times,an anesthesiologist may be called upon to Provide specific anesthesia services to a patient undergoing planned procedure,when patient may receive local or no anesthesia at all MAC should be reported by
19、 using Modifier QS Documentation for medical necessity Should be evident in patients record Medicare Wants modifier G8 or G9 to be reported,if applicableProcedural Coding Spine and Spinal Cord(00600-00670)New codes for 2007 00625 Anesthesia for procedures on the thoracic spine and cord,via an anteri
20、or transthoracic approach;not utilizing one lung ventilation 00626 Anesthesia for procedures on the thoracic spine and cord,via an anterior transthoracic approach;utilizing one lung ventilationProcedural Coding Knee and Popliteal Area(01320-01444)Regional anesthesia for knee surgery has three separa
21、te steps Epidural/spinal anesthesia pain during the surgery Femoral nerve block helps to manage pain after the surgery Sedation during surgery Lower Leg(Below Knee,Includes Ankle and Foot)(01462-01522)Sciatic nerve used to numb only the leg and foot scheduled for surgery Other leg not affected When
22、needle is close to correct position,patients foot will move on its own Once needle in proper position,nerve block medicine is injectedProcedural Coding Shoulder and Axilla(01610-01682)Nerves of should and arm Located on side of the neck,just above collarbone Single injection into nerves will numb sh
23、oulder for 12-24 hours Numbing affects only the side scheduled for surgery Radiological Procedures(01905-01933)Interventional radiology using fluoroscopy,ultrasound,CT and MRI Often performed under local anesthesia with IV sedation General anesthesia may be provided to patients who have had difficul
24、ty with sedation,or have coexisting medical conditionsProcedural Coding Burn Excisions or Debridement(01951-01953)Local or general anesthesia May be used when surgically debriding burns Tip:Burns in the ORmost burns(58%)in the OR are from devices used to warm the patient,including IV bags and warmin
25、g devices,cautery devices caused from burns either by grounding pads or by causing a fire.Miscellaneous devices associated with burns included MRI,retractors,defibrillator paddles,and ECG leads.Procedural Coding Obstetrical Anesthesia(01958-01969)Several different forms of anesthesia administered fo
26、r childbirth May be used independently or in conjunction with one another Most commonly administered Local RegionalQualifying Circumstances Anesthesiologists and CRNAs should use these add-on codes to report Situations that make administering anesthesia particularly difficult Medicare does not pay f
27、or the following add-on services+99100 Anesthesia for a patient of extreme age,under one year or over 70+99116 Anesthesia complicated by utilization of total body hypothermia+99135 Anesthesia complicated by utilization of controlled hypotension+99140 Anesthesia complicated by emergency conditions(sp
28、ecify)Moderate Conscious Sedation(99143-99150)Located in the Medicine Section of CPT Drug induced depression of consciousness Allows patient to Respond purposefully to verbal commands,either alone or accompanied by light tactile stimulation May be administered in Hospitals Outpatient facilitiesModer
29、ate Conscious Sedation(99143-99150)Services that are included in moderate conscious sedation Assessment of patient(not included in intraservice time)Establishment of IV access and fluids to maintain patency,when performed Administration of agent(s)Maintenance of sedation Monitoring of oxygen saturat
30、ion,heart rate,and blood pressure Recovery(not included in intraservice time)Code 99143clarifies use of moderate conscious sedation services;sedation provided by same physician performing the diagnostic/therapeutic service,younger than 5 years of age,first 30 minutes of intraservice timeCodes 99144
31、and 99145further clarify age and time constraintsCode 99148clarifies use of a second provider;under age 5 years of age,first 30 minutes intraservice timeAnesthesia Crosswalk Anesthesia codes Do not often correspond on a one-to-one basis with surgery codes Approximately 40,000 Surgical,medical and radiological procedures represented by nearly260 anesthesia codes Anesthesia codes Arranged based on anatomical areas Important to utilize a crosswalk such as ASA Crosswalk A Guide for Surgery/Anesthesia CPT CodesThe End
