2007–PMCC

Anesthesia

Chapter18ChapterOutlineIntroducestudentstoFormsofanesthesiaAnesthesiaguidelinesAnesthesiamodifiersAnesthesiaGuidelinesAnesthesiaserviceincludesUsualpreoperativeandpostoperativevisitsAdministrationoftheanestheticforthesiteofsurgeryAnesthesiacareduringtheprocedureAdministrationoffluidsand/orbloodreplacementInterpretationofnoninvasivemonitoring(bloodpressure,ECG,temperature,oximetry,apnography,andmassspectrometry)TimeKeyelementforreimbursementStartswhenanesthesiologistbeginspreparingpatientinOREndswhenanesthesiologistnolongerinpersonalattendanceandpatientissafelyplacedunderpostoperativesupervisionAnesthesiaModifiersThreesetsofmodifierstoconsiderPhysicalstatusHCPCSCPTCPTmanualalsoincludescodesforReportingcircumstancesthatcouldincreasethedifficultyofprovidinganesthesiaPhysicalStatusModifiersP1—Normal,healthypatientP2—Patientwithmildsystemicdisease(eg,mild,benign,hypertensiveheartdisease)wellcontrolledonmedicationP3—Patientwithseveresystemicdisease(eg,benign,hypertensiveheartandrenaldiseasewithcongestiveheartandrenalfailure)P4—Patientwithseveresystemicdiseasethatisaconstantthreattolife(eg,hypertrophicobstetriccardiomyopathywithESRD)awaitinghearttransplantP5–MoribundpatientwhoisnotexpectedtosurvivewithoutsurgeryP6—AdeclaredbraindeadpatientwhoseorgansarebeingremovedfordonorpurposesCPTModifiers22—UnusualProceduralServices23—UnusualAnesthesia(Identifiesaprocedurethatusuallyrequiresnoanesthesiaorlocalanesthesia.Underunusualcircumstances,generalanesthesiaisrequired)32—MandatedServices51—MultipleServices53—DiscontinuedProcedure59—DistinctProceduralService(Identifiescertaincircumstanceswhenaphysicianmayneedtoindicatethataprocedure/servicewasdistinctorindependentfromotherservicesperformedonthesameday)HCPCSLevelIIModifiersAA—AnesthesiaserviceperformedpersonallybyanesthesiologistAD—Medicalsupervisionbyaphysician:morethanfourconcurrentanesthesiaproceduresG8—Monitoredanesthesiacare(MAC)fordeepcomplex,complicated,ormarkedlyinvasivesurgicalprocedureG9—MonitoredanesthesiacareforpatientwhohashistoryofseverecardiopulmonaryconditionQB—PhysicianprovidingserviceinaruralHPSAQK—Medicaldirectionoftwo,three,orfourconcurrentanesthesiaproceduresinvolvingqualifiedindividualsQS—Monitoredanesthesiacareservice(MAC)QX—Certifiedregisterednurseanesthetist(CRNA)service,withmedicaldirectionbyaphysicianQY—Medicaldirectionofonecertifiedregisterednurseanesthetist(CRNA)byananesthesiologistQZ—CRNAservice,withoutmedicaldirectionbyaphysicianTypesofAnesthesiaGeneralAnesthesiaResultsinlossofconsciousnessProducesamnesiabyblockingtheawarenesscenterinthebrainCPTcodes00100-01999representgeneralanesthesiaunlesscodedescriptionstatesotherwiseRegionalAnesthesiaBlocksallpainfulsensationtothespecificregionofthebodyinnervatedbythenerveornerveplexusreceivingtheanestheticDoesnotinduceunconsciousnessTypesofAnesthesiaPeripheralNerveBlocksAnesthetizeindividualnervesornerveplexusesAnestheticagentinjectedalongthenerveratherthaninthenerveCodes64400-64530UsedtodescribetheseservicesNerveBlocksAnesthetizeentireregionsSpinalAnesthesiaUsedformajorproceduresperformedbelowlevelofthediaphragmRelativelysafeProvidesexcellentmusclerelaxationAccomplishedbyplacingneedlebetweenthevertebraeandinjectinganestheticagentintothesubarachnoidspaceFrequentlyusedforpainmanagementbyanesthesiologistsTypesofAnesthesiaEpiduralAnesthesiaAchievedbyinjectinganestheticagentintoepiduralspaceofthoracicorlumbarinterspacesUsuallyavoidpostoperativeheadachesIntravenousRegionalBlocksUsedforsomeproceduresonextremitiesPneumatictourniquetappliedtothelimbandanestheticagentisinjectedintotheveinofthelimbdistaltothetourniquetFieldBlockUsedtoformbarrierbetweenoperativesiteandnervoussystemAccomplishedbymultipleinjectionsoflocalanestheticagentLocalAnesthesiaAppliedtopicallyorbylocalinfiltrationPainManagementBenefitsofproperpainmanagementShorterhospitalstaysIncreasedmobilizationAcutePainMaybeexperiencedduringpostoperativeperiodIncludedinsurgeon’sfeeShouldonlybeturnedovertoaspecialistwhenspecialcircumstanceswarrantthislevelofserviceDocumentationmustexistwithinmedicalrecordtoindicatewhyservicesofanesthesiologistareneededPainManagementPainmanagementoptionsmayincludeCognitive,behavioralinterventionssuchaseducation,relaxation,distraction,biofeedbackSystemicadministrationofanonsteroidalanti-inflammatorydrugs(NSAID)oropiatesPatientcontrolledanalgesia(PCA)SpinalanalgesiaIntermittentorcontinuousnerveblockPhysicalagents(eg,massage)applicationofheatorcoldmodalitiesTranscutaneouselectricalnervestimulator(TENS)ChronicPainPainthatdoesnotresolveitselfafter3-6monthsTreatedbyvarietyofmodalitiesMonitoredAnesthesiaCare(MAC)Attimes,ananesthesiologistmaybecalledupontoProvidespecificanesthesiaservicestoapatientundergoingplannedprocedure,whenpatientmayreceivelocalornoanesthesiaatallMACshouldbereportedbyusingModifierQSDocumentationformedicalnecessityShouldbeevidentinpatient’srecordMedicareWantsmodifierG8orG9tobereported,ifapplicableProceduralCodingSpineandSpinalCord(00600-00670)Newcodesfor200700625Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;notutilizingonelungventilation00626Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;utilizingonelungventilationProceduralCodingKneeandPoplitealArea(01320-01444)RegionalanesthesiaforkneesurgeryhasthreeseparatestepsEpidural/spinalanesthesiapainduringthesurgeryFemoralnerveblockhelpstomanagepainafterthesurgerySedationduringsurgeryLowerLeg(BelowKnee,IncludesAnkleandFoot)(01462-01522)SciaticnerveusedtonumbonlythelegandfootscheduledforsurgeryOtherlegnotaffectedWhenneedleisclosetocorrectposition,patient’sfootwillmoveonitsownOnceneedleinproperposition,nerveblockmedicineisinjectedProceduralCodingShoulderandAxilla(01610-01682)NervesofshouldandarmLocatedonsideoftheneck,justabovecollarboneSingleinjectionintonerveswillnumbshoulderfor12-24hoursNumbingaffectsonlythesidescheduledforsurgeryRadiologicalProcedures(01905-01933)Interventionalradiologyusingfluoroscopy,ultrasound,CTandMRIOftenperformedunderlocalanesthesiawithIVsedationGeneralanesthesiamaybeprovidedtopatientswhohavehaddifficultywithsedation,orhavecoexistingmedicalconditionsProceduralCodingBurnExcisionsorDebridement(01951-01953)LocalorgeneralanesthesiaMaybeusedwhensurgicallydebridingburnsTip:BurnsintheOR—mostburns(58%)intheORarefromdevicesusedtowarmthepatient,includingIVbagsandwarmingdevices,cauterydevicescausedfromburnseitherbygroundingpadsorbycausingafire.MiscellaneousdevicesassociatedwithburnsincludedMRI,retractors,defibrillatorpaddles,andECGleads.ProceduralCodingObstetricalAnesthesia(01958-01969)SeveraldifferentformsofanesthesiaadministeredforchildbirthMaybeusedindependentlyorinconjunctionwithoneanotherMostcommonlyadministeredLocalRegionalQualifyingCircumstancesAnesthesiologistsandCRNAsshouldusetheseadd-oncodestoreportSituationsthatmakeadministeringanesthesiaparticularlydifficultMedicaredoesnotpayforthefollowingadd-onservices+99100—Anesthesiaforapatientofextremeage,underoneyearorover70+99116—Anesthesiacomplicatedbyutilizationoftotalbodyhypothermia+99135—Anesthesiacomplicatedbyutilizationofcontrolledhypotension+99140—

Anesthesiacomplicatedbyemergencyconditions(specify)ModerateConsciousSedation(99143-99150)LocatedintheMedicineSectionofCPTDruginduceddepressionofconsciousnessAllowspatienttoRespondpurposefullytoverbalcommands,eitheraloneoraccompaniedbylighttactilestimulationMaybeadministeredinHospitalsOutpatientfacilitiesModerateConsciousSedation(99143-99150)ServicesthatareincludedinmoderateconscioussedationAssessmentofpatient(notincludedinintraservicetime)EstablishmentofIVa