General Introduction to Anesthesia Coding – PART 1

In Modern medicine, Anesthesia plays a significant role in performing both major and minor surgeries. Anesthesia coding is a unique speciality which requires a special skill-set of coding both the CPT and the ASA coding system. Coders must require an extensive training, hands-on experience and continuous learning to assign the Anesthesia codes.

This Introductory part is divided into three parts and this article includes the PART 1.

What is Anesthesia?

Anesthesia is a temporary induced loss of sensation or awareness. It may include

  • analgesia (relief from or prevention of pain)
  • paralysis (muscle relaxation)
  • amnesia (loss of memory) or
  • unconsciousness

A patient under the effects of anesthetic drugs is referred to as being “anesthetized.”

Types of Anesthesia:

  • General
  • Regional: Spinal and Epidural Anesthesia
  • Local
  • Monitored Anesthesia care (MAC)

General Anesthesia: General Anesthesia renders the patient completely unconscious and with no memory of the surgical procedure upon awakening. There are a number of general anesthetic drugs – some are gases or vapors inhaled through a breathing mask or tube and others are medications introduced through a vein.

Regional anesthesia:

In this type, anesthesiologist makes an injection near a cluster of nerves to numb the area of your body that requires surgery.

You may remain awake, or you may be given a sedative, either way you do not see or feel the actual surgery taking place.

There are several kinds of regional anesthesia. The most common are

1. Spinal anesthesia

2. Epidural anesthesia.

Spinal Anesthesia: A form of regional anesthesia involving the injection of a local anesthetic into the subarachnoid space, generally through a fine needle.

Spinal anesthetics are typically limited to procedures involving most structures below the upper abdomen. It blocks the transmission of afferent nerve signals from peripheral nociceptors. Sensory signals from the site are blocked, thereby eliminating pain.

Epidural Anesthesia: This is injected into an area outside the spinal column called the epidural space. A small tube or catheter is inserted into the epidural space, which allows the anesthesiologist to administer more medication as needed. Often employed during childbirth

Local Anesthesia:

In local anesthesia, the anesthetic drug is usually injected into the tissue to numb just the specific location of your body requiring minor surgery.

Monitored Anesthesia Care (MAC):

MAC is a specific anesthesia service in which an anesthesiologist is continuously with the patient. The anesthesiologist is completely devoted to monitoring and caring for the patient so the surgeon can focus on the operation.

MAC is intravenous sedation. The patient may still be awake during the procedure, but will be in a more relaxed state. Monitored anesthesia may be necessary if the patient is undergoing an invasive procedure, or if the patient has a history of severe cardiopulmonary condition.

Types of Anesthesia Providers:

  • Anesthesiologist
  • Anesthesiology Resident
  • Certified Registered Nurse Anesthetist (CRNA)
  • Anesthesiologist Assistant (AA)
  • Student Nurse Anesthetis
  • Anesthesiologist Assistant Student

Who makes the rules?

ASA: (American Society of Anesthesiologists)

Standards: Provide rules or minimum requirements for clinical practice

Guidelines: Systematically developed recommendations that assist the practitioner and patient in making decisions about health care

Statements: Represent the opinions, beliefs, and best medical judgments of the House of Delegates

ASA Resources:

Relative Value Guide (RVG)

  • The Relative Value Guide is an essential tool for all anesthesia practices. RVG provides an explanation of anesthesia coding, including definitions of base units, anesthesia start/stop time, field avoidance, reporting time for neuraxial labor anesthesia services and other important elements of anesthesia billing.

Anesthesia Crosswalk

  • Links surgical procedure(s) performed to the appropriate anesthesia service code

Anesthesia record:

The following are the information required from the Anesthesia medical record to aid in appropriate coding:

  • The date, signature and times for the case( start and stop time)
  • Who was involved? (Anesthesiologist, CRNA, Resident)
  • Was the case medically directed and is there appropriate documentation to indicate presence for the important aspects of the case?
  • Concurrency (how many cases were performed or medically directed during the same time frame by the Anesthesiologist)
  • Type of anesthesia administered ( Types of anesthesia include regional, epidural, general, moderate conscious sedation (some CPT codes include moderate sedation), or monitored anesthesia care (MAC)
  • The procedure performed with the highest value to the anesthesiologist is used for both the CPT and ASA codes
  • Include diagnoses and any significant conditions reported that would contribute to the complexity of caring for the patient during the case (CAD, COPD, DM, anxiety, etc.)
  • Modifying factors (physical status, qualifying circumstances)
  • Additional procedures (Art lines, CVP, Swan Ganz, Epidurals or blocks for post pain management only)

WHAT’S INLCUDED IN ANESTHESIA SERVICES?

  • Pre-operative and post-operative visit
  • Administration of fluids and/or blood
  • Usual monitoring services (eg,ECG, temperature, blood pressure, oximetry, capnography, and mass spectrometry)
  • Laryngoscopy (31505, 31515, 31527)
  • Bronchoscopy (31622, 31645, 31646)
  • Introduction of needle or catheter (36000-36015)
  • Venipuncture or transfusion (36400-35440)
  • Blood sample procurement through existing lines
  • Otorhinolaryngologic services (92511-92520, 92543)
  • CPR (92950)
  • Temporary transcutaneous pacemaker (92953)
  • Cardioversion (92960)
  • ECG/EKG (93000-93010)
  • Cardiovascular Stress Tests (93015-93018)
  • Retrobulbar injection (67500)
  • Interpretation of lab tests (81000-81015, 82013, 82205, 82270, 82271)
  • Injections and IV drug administration (96360-96375)
  • Esophageal, gastric intubation (91000, 91055, 91105)
  • Injection of diagnostic or therapeutic substances (62310-62311, 62318-62319
  • Nerve blocks (64400-64530)
  • Transesophageal echo (TEE) (93312-93318)

Each of the three services (highlighted in bold italics) listed above may be separately reportable in certain circumstances. In those circumstances, modifier 59 should be appended to the CPT® code for the procedure(s) performed.

Services Not Included in Base Unit Values:

Additional benefits are provided for the following services, as they are not considered included in the base unit values and may be reported separately.

  • Swan-Ganz catheters (93503)
  • Arterial lines(36620, 36625)
  • CVP lines (36555, 36556, 36557-36558)
  • Lines to superior or inferior vena cava

Anesthesia Procedure Codes:

In the next article PART 2, factors affecting anesthesia services and other important definitions will be discussed…..stay connected.

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