Anesthesia:
To Learn Anesthesia the first step we should know Types of Anesthesia
There are 5 types of anesthesia can be given to patient by physician
1. Local Anesthesia- Local anesthesia is not a billable service and no need to
provide CPT code if physicians give local anesthesia.
2. Topical Anesthesia- Topical anesthesia is not a billable service and no need
to provide CPT code if physicians give local anesthesia.
3. Regional Anesthesia- This type of anesthesia can be billed with CPT code
4. Epidural Anesthesia- Spine This type of anesthesia can be billed with CPT
code
5. General Anesthesia- via Mask/or IV line This type of anesthesia can be billed
with CPT code
Next thing we should know Who can provide Anesthesia:
Anesthesia can be provided by
1. Anesthesiologist - (AA Modifier)
2. CRNA- Certified Registered Nurse Anesthesiologist (QZ modifier)
3. Surgeon (47 modifier)
Rule1: If anesthesia provided by anesthesiologist in that case medical coder need to
use - AA modifier with Anesthesia CPT code i.e., 01214-AA (Anesthesiologist)
Rule2: If anesthesia provided by Certified Registered Nurse Anesthesiologist in this
case Medical coder need to be used QZ modifier along with Anesthesia CPT Code
i,e. - 01214- QZ
Rule3: If anesthesia provided by surgeon in this case medical coder need to use 47
modifier along with anesthesia CPT code i.e. 01214-47
Coding Tip: AA, QZ or 47 modifiers only need to be used if service provided
independently by any of the service providers. If there are more than one person
involved in anesthesia Service, we have different rules.
If more than one person involved in Anesthesia Service
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Rule1: Anesthesiologist supervises one CRNA If CRNA gives anesthesia under
supervision of anesthesiologist in that case both CRNA and Anesthesiologist will
send a claim to insurance company but they will use modifier to justify their services.
Anesthesiologists will use a QY modifier along with anesthesia CPT code.
CRNA will use same CPT code used by anesthesiologist but with QX modifier
Hip Arthroplasty (Correct method)
Anesthesiologist CRNA
01214-QY 01214-QX
If a medical coder used AA and QZ modifier in above example insurance company
will decline claim.
Rule2: Anesthesiologist supervises multiple CRNA at same time
If an anesthesiologist supervises multiple CRNA’s (up to 4 at a time) use same CPT
code twice
For anesthesiologist with QK modifier
Same CPT code for designated CRNA with QX modifier.
Operation CPT code for CPT code for
Theater # Procedure Anesthesiologist Anesthesiologist CRNA CRNA
1 Pacemaker John 00530-QK A 00530-QX
2 Hip Arthroplasty John 01214-QK B 01214-QX
Knee arthroscopy
3 surgery John 01400-QK C 01400-QX
Tonsillectomy and
4 Adenoidectomy John 00170-QK D 00170-QX
We can not use AA or QY modifiers with Anesthesiologist if the anesthesiologist
supervises more than one CRNA. If these modifiers are used, the insurance
company will decline the claim.
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Coding tip: If no of CRNA supervise by Anesthesiologist more then 4 and up-to 6
we will use AD modifier for Anesthesiologist
PAC- Preanesthesia Check up
Physical Status Modifiers:
P1: Normal healthy patient
P2: Patient with mild systemic disease
P3: Patient with severe systemic disease
P4: Patient with severe systemic disease that is a constant threat to life
P5: Moribund patient. Patient cannot survive without surgery - Major trauma/Accident
P6: Brain dead patient (normally for organ donation)
Modifying Factor:
Physical status modifier has different values i.e.
P1 (0)
P2 (0)
P3 (1)
P4 (2)
P5 (3)
P6 (0)
Base Unit/Base Price: Every anesthesia code has a base unit. Minimum of 3. The
base unit value is reflective of the difficulty and skill required for the procedure. Base
units are constant and do not change. To find base unit either go through Encoder
pro ( it is a coding search software) or ASA crosswalk (Separate book).
Anesthesia Time: Anesthesia time starts when the anesthesiologist starts
preparation of the patient for the procedure and ends when he is no longer in care of
the patient. There is no correlation between surgery start and complete time with
anesthesia time. Try to calculate anesthesia time in minutes.
Calculation of Time units : One time unit is equal to 15 minutes. Total time spent
by anesthesiologist (in minutes) divided by 15. No need to put the result in decimal. If
the remainder is 8 or more than 8 add one additional time unit. If the remainder is
less than 8 no need to add any additional time unit.
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Example:
Anesthesia time 65 minutes
Time Unit= 65/15 Quotient= 4 Remainder= 5
Time unit = 4
Example 2: Anesthesia time 68 minutes
Time Unit= 68/15 Quotient= 4 Remainder= 8
Time unit = 4+1= 5
How to calculate anesthesia time and time unit: Anesthesiologist started
preparation of the patient at 9:00 am. Patient was taken to the OT at 9:30 am.
Surgery lasted till 10:30 am and the patient was recovered by the anesthesiologist at
11:00 am. Anesthesiologist left patient care at 11:30 am.
Anesthesia time= 150 min
Anesthesia unit= 150/15= 10
Conversion Factor (Common Factor): Decided every year by the Govt. i.e ($100)
for one Anesthesia Unit
Formula for calculating Anesthesia charges: (Base unit + Time unit + modifying
Factor) X Conversion Factor
Example: Anesthesiologist started preparation of the patient who has severe
systemic Disease for Knee Arthroscopy at 9:00 am. Patient was taken to the OT at
9:30 am. Surgery lasted till 10:30 am and patient was recovered by the
anesthesiologist at 11:00 am. Anesthesiologist left patient care at 11:30 am.
Conversion factor for year is $40. Base unit of Knee arthroscopy is 5.
Anesthesiologist Charges= (Base unit + Time unit + modifying Factor) X
CoNVERSION Factor
Base unit -5
Time= 150 min time unit 150/15= 10 unit
Modifying= P3= 1
Conversion Factor 40
=(5+10+1)x40= 16X40= $640
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Monitored anesthesia Care (MAC). If an anesthesiologist provides
monitored anesthesia care use the QS modifier.
G8 modifier:
MAC for deep, complex, complicated or markedly invasive surgery:
G9 modifier
MAC for a patient who has a history of SEVERE CARDIOPULMONARY disease
Coding tip:
QS and G9 modifier cannot bill along with with G8 modifier
QS modifier can be billed with G9
Maximum time we only use QS modifier for Monitored Anesthesia care.
Unusual anesthesia: Procedure not required anesthesia normally on the request of
a patient physician gives anesthesia in that case we need to append modifier 23.
Qualifying Circumstances: (These are add on codes which need to code along
with Anesthesia codes)
+99100: use this code with the anesthesia code if the patient's age is less than 1
year or greater than 70 years. There are 4 CPT codes (00326, 00561, 00834, 00836)
that do not require +99100. That means if those codes are used no need to put
99100
+99116- Use this code if patient has hypothermia- Low Temperature
+99135- Use this code if patient has hypotension - Low Blood pressure
+99140 Use this code if surgery has been performed in emergency
We can use any number of Qualifying Circumstances in a single report until they
meet the criteria.
Never use any modifier along with qualifying circumstances codes.
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Basic CPT Rule:
Parent Code- Parent code always start with Capital Letter. Meaning of Parent code
is always complete.
Child Code- Child code always starts with a small letter or number. Meaning of child
code is incomplete unless we add description of parent code before semicolon in
child code.
If there is no semicolon in parent code that means a full description of Parent code
need to be added in child code.
00124- Anesthesia for procedures on external, middle, and inner ear including
biopsy; otoscopy.
00148- Anesthesia for procedures on eye; ophthalmoscopy
00142- Anesthesia for procedure on eye; lens surgery
Some important CPT code from Anesthesia
00142- Lens Surgery (Cataract surgery)
00170- Intraoral procedures (Dental treatment/ Tonsillectomy and Adenoidectomy)
00215 (CPC Exam)
Anesthesia for Skin:
00300- (Posterior Trunk- Back), head and Neck
00400- (Anterior Trunk- Abdomen, Chest) Extremity- Arm and legs, Genital organ
00520- Bronchoscopy
00528- Diagnostic Thoracosopy without utilizing one lung ventilation
00529 utilizing one lung ventilation
00530- Pacemaker
00532- CVP- Central Venous pressure
00534- AICD (Automated Cardioverter Defibrillator)
00537- EPS STudy of Heart (EPS- Electrophysiology study)
00540
00541
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00562- (CPC Exam)
00566 CABG no using pump oxygenator
00567- CABG using pump oxygenator
(Pump oxygenator also known as heart Lung bypass or Cardiopulmonary
bypass)
00731
00732
00770
00790
00830
00832
00840
00851- Tubal Ligation ( Sterilization procedure in females)
00921- Vasectomy ( Sterilization procedure in Male )
00872- ESWL- Extracorporeal shock wave lithotripsy
00873- ESWL - Without water bath
00902
00910
00912
00914
01214- Hip arthroplasty
Types of procedures on Musculoskeletal systems.
Bone- Open or closed
Muscles
Arteries/Vein
Joinit (Arthroscopy, Joint replacement)
There are two types of arthroscopy diagnostic and Surgical
01810- Carpal Tunnel Syndrome
01958- CPC
01960
01961- CPC
01967-CPC
01968-CPC
01969-CPC
01991- steroid Injections (Other then Prone position)
01992- Prone Position
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01996- Daily Pain Management - Use this code on a daily basis once per day. Never
use this code on the day of surgery. Surgery day pain management included in
Anesthesia procedure.
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