CHAPTER 16
ANESTHESIA
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 1
Anesthesiologist
• Doctor of medicine specialized in
anesthesia
• Usually independent practices
(not hospital employees)
– e.g., Anesthesia Associates, Inc. or Pain
Clinic, Ltd.
• Services reported separately
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 2
Uses of Anesthesia
• Relieve pain
• Manage
– Unconscious patients
– Life functions
– Resuscitation
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 3
Methods of Anesthesia
Figure: 16.1A
• Endotracheal: Through mouth
(Cont’d …)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 4
Methods of Anesthesia
Figure: 16.2
• Local: Application to area (injection or topical)
(Cont’d …)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 5
Methods of Anesthesia
(…Cont’d)
• Epidural: Into epidural space
• Regional: Field or nerve
– Includes spinal and epidural
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 6
Patient-Controlled Analgesia (PCA)
• Patient administers drug
• Often used to control acute post-op or
chronic pain
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 7
Moderate (Conscious) Sedation
• Patient controls his/her airway and can
respond to verbal commands
• General renders the patient unconscious
• Decreased level of consciousness
• Report with 99143-99150 (Medicine)
• Codes divided on:
– Age > or < 5
– Time
– Provided by physician performing service (9914399145) or other physician (99148-99150)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 8
Anesthesia Section Format
Figure: 16.4
• Anatomic divisions
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 9
Anesthesia Formula
• B+T+M
1. Base units
2. Time units
3. Modifying units
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 10
B is for Base Unit
• Published in RVG (Relative Value
Guide™) by ASA
• National unit values for anesthesia
services
– Based on complexity
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 11
Relative Value Guide™ (RVG)
• Lists all CPT anesthesia codes
• Italicized comments added to ASA’s
RVG
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 12
Relative Value Guide
Figure: 16.8
Courtesy U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
• Base Unit Values assigned to each code
(Cont’d …)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 13
Relative Value Guide
(…Cont’d)
• Anesthesia services paid on set amount
per unit (conversion factor)
• Example: Medicare unit value, North
Carolina in 2010 was $20.74
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 14
T is for Time
• Patient record indicates time, e.g., 15,
30, 60 minutes
• Often, 15 minutes = 1 unit
• 60 minutes = 4 units
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 15
T is for Time
(…Cont’d)
• Begins: Anesthesiologist begins to
manage patient in the operating room—preop
• Continues throughout procedure—intraop
• Ends: Patient no longer under care of
anesthesiologist—postop
• Example: Anesthesia time started at 9 AM and
the patient discharged to PACU at 1:30 PM
would be 270 minutes.
• PACU = Post-Anesthesia Care Unit
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 16
M is for Modifying Unit
• Physical condition indicated by physical
status modifier
• P1 – P6, in Anesthesia Guidelines
• Risk Factor
• Not reported for Medicare
(Cont’d …)
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Slide 17
Physical Status Modifiers,
P1 through P6
(…Cont’d)
•
•
•
•
P1 Normal, healthy
P2 Mild systemic disease
P3 Severe systemic disease
P4 Severe systemic disease and in constant
threat to life
• P5 Not expected to survive without operation
• P6 Brain dead
(Cont’d…)
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 18
Physical Status Modifiers
(…Cont’d)
• Payment differential based on some physical
status ratings
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 19
Another Modifying Unit
• Qualifying Circumstances, 99100–99140
• In Anesthesia Guidelines
• Also in Medicine section
• Not reported for Medicare
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 20
Qualifying Circumstances Codes
and Relative Value
Figure: 16.10
Excerpted from 2010 Relative
Value Guide, © 2009 of the
American Society of
Anesthesiologists. All Rights
Reserved. Relative Value
Guide is a registered trademark
of the American Society of
Anesthesiologists. A copy of the
full text can be obtained from
ASA, 520 N. Northwest
Highway, Park Ridge, IL,
60068-2573.
• Listed in addition to primary anesthesia code
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 21
Summation of Formula
• Base units (from RVG) based on CPT
codes
• Time units (often, 15 min. = unit)
• Modifiers [Qualifying Circumstances
(99100–99140) and/or Physical Status
(P1-P6)]
• B+T+M=Total Units  $ (CF) = payment
– CF = Conversion factor
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 22
Conversion Factors
Figure: 16.13
• CMS Anesthesia Conversion Factors
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Slide 23
Anesthesia for Multiple
Surgical Procedures
• Once anesthetized, length of time not
number of procedures
(Cont’d …)
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Slide 24
Multiple Service
(…Cont’d)
• Example: two procedures during same
session
– One, 10 base unit value; the other, 5 base
unit value
– Report only 10 base unit value
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 25
HCPCS Modifiers
• Added to anesthesia code
• -AA = Anesthesia by Anesthesiologist
• -AD Physician, medical supervision, 4+ concurrent procedures
• -G8 MAC (monitored anesthesia care), complex procedures
• -G9 MAC, patient history of severe cardiopulmonary condition
• -QK Qualified individual, medical supervision 2, 3, 4
• -QS MAC
• -QX CRNA, directed by physician
• -QY MAC, anesthesiologist of one CRNA
• -QZ CRNA, without direction
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Slide 26
Conclusion
CHAPTER 16
ANESTHESIA
Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 27