Anesthesia Coding
Oh right, anesthesia.
I like doing the anesthesia coding maybe because itís gotÖ itís like E&M but itís smaller.
It has its own little area in the CPT book and once you know the basics, youíre good
to go.
Thereís really not that many anesthesia codes when you compare it to the volume of the CPT.
The first thing you need to know, thereís 3 things you basically need to know when youíre
doing, again, basic anesthesia coding.
You need to know type, the BTM and find the code.
So letís click on the answer here and letís look at the paper that I worked up.
Oh, thatís very tiny.
Oh, there we go.
Alright, the first thing you want to do, what type of anesthesia are you dealing with?
So these are the types that you work with.
Thereís endotracheal, epidural, spinal, general, regional, local and then patient-controlled.
But really, patient-controlled is a little bit different because thatís when they give
you that morphine pump.
If youíve ever had to have that and the patient literallyÖ you know, itís set up that it
canít be you know, given closer than every 30 minutes and the patient can give them the
morphine when they want it so the nurse doesnít have to keep coming in.
Endotracheal is whatever they put a tube down someoneís throat into the trachea and thatís
for any type of procedure that they do where theyÖ
you know, when people say, ìWell, they put me under.î Or youíre having you know, major
surgery, then thatís the type theyíre going to do.
Also, youíll have a separate report, an anesthesia report as well as an op report.
You donít want to get those confused.
When you do itÖ wen you do an op report, youíre coding for what the doctor does, the
procedure that he did to you.
Then it will say, maybe on there, you know the type of anesthesia that was given.
But when you look at your bill, youíll also see that the anesthesiologist billed you as
well.
Heís a physician and he is going to get paid for his services and he writes a separate
report.
Letís see, epidural.
You know, a lot of women are familiar with epidurals and thatís what you hear in the
movies when the women are pregnant and they scream, ìI want my epidural.î And thatís
what it does, it blocks everything from the waist down.
And the anesthesiologist or CRNA which is a certified nurse anesthesist, they come in
and they give you that epidural block, pretty common now.
An op report is doneÖ itís not an op report.
There is a report given for that as well.
Spinal, a little bit different than epidural.
General, this is what somebodyÖ some people get confused about.
A general is not the same as when you go in to have like a hip replacement.
Theyíre going to give you the endotracheal anesthesia.
But a general is maybe when youíre going in for a colonoscopy or youíre going in to
a procedure where theyíre not really putting you to sleep per se.
Theyíre putting you in a sedated state and then they you know, you come out of that pretty
quickly and then you know, you get to go home and itís notÖ when they put you under for
a procedure with endotracheal you know, they have to observe you for a lot longer than
they do if they give you a general.
Now regional blocks, this is where youíve got a laceration, say on your hand.
And you know, when they do that, they just give you like 5 injections of the Xylocaine
and they stitch you up.
Thatís a general circle or a wall of anesthetic that numbs that area.
But they can also do a block that way.
If you areÖ say youíve got a large laceration thatís going to be a complicated repair,
complex repair on the arm and you know, you can only have like 8 cc of Xylocaine or Lidocaine
or whatever theyíre giving you before it can be toxic to the heart because you know,
it is you know, numbing you.
So what theyíll do is theyíll say, ìWell, Iím just going to give him a block.î And
they start at the elbow and they inject it in and it blocks the pain from anything from
the elbow down.
So they can do just like a wheel around where the wound is or they can block it completely
at like a joint is kind of where they do.
Topical, this is what youíre familiar with.
If you go to theÖ if you go off to the pharmacy and you just get a topical analgesic that
will just numb the skin.
You know, when you putÖ babies are teething and you put that gel.
Thatís classified as a topical.
Thereís alsoÖ thereís some topical stuff that you can get from the ER for burns and
stuff.
I think Silvadene cream is you know, considered topical or gets into the tissues.
Okay, letís scroll down just a little bit on this page.
The next thing weíre going to look at is the BTM.
Thereís a formula thatís used with anesthesia and this is how they get reimbursed.
Itís divided up on base units, time units and modifying units.
To get the base units, what they do is they take every anesthesia code and most of those
codes, you donít start it with a 00.
Theyíre at the beginning of your code book.
And for each one procedure, theyíre given a value.
And I canít remember, itís like 1 to 20 maybe, I guess.
I donít know if I ever received one more than 18.
But here are what, 5 codes that I just pulled off the cms.gov website.
And it just so happened that 00635 has a base unit of 4.
Thatís for a lumbar puncture.
Okay so preÖ you know, itís relatively simple procedure for somebody do a lumbar puncture.
Theyíre just you know, sticking a needle in your back.
Okay soÖ then you go to 00670.
That is the code for spine ñ open surgery on the spine.
Now, say theyíre going to go in and put plates or rods on your spine because you have scoliosis
or something like that.
Thatís the code for that.
Thatís a much more detailed procedure.
So it gets a 13 when youíre adding up the base units.
And it will be the equivalent to have in like open heart surgery or your tonsils taken out.
Well, open heart surgeryís going to have a higher base unit value than having your
tonsils taken out or you will run situations like ìHey, you have an appendectory and a
cholecystectomy.î Well, if they take your gallbladder out and your appendix out at the
same time, they probably haveÖ itís just about the same type of a procedure, same area.
TheyíreÖ the base value is going to be the same, you know.
So it doesnít matter which one you list first.
So letís go downÖ the next thing you need to know is the time units.
This is real important and I can guarantee you, there are test questions on the time
for anesthesia.
Be prepared, I canít remember, thereís onlyÖ I think there is maybe 8 anesthesia questions
on the CPC exam and one of them will most likely be on coming up with the time, how
to measure time for the anesthesia.
What you need to know there is that time starts for the anesthesiologist from the point he
walks into your room and starts discussing your procedure with you.
He starts the clock then.
Now, when youíre reading the op report, itís going to say you know, procedure for the cholecystectomy
started at 9:15 and was completed at 10 oíclock.
But the anesthesiologist report is going to say that he met with the patient at 9 oíclock
and reviewed allergies you know, and asked questions like, ìHave you ever had anesthesia
before?î, all that stuff that he goes over with you before.
And then he released the patient to the recovery room nurse at 9:15.
So his time goes from 9 oíclock toÖ excuse me, 10:15 whereas the op only went from 9:15
to 10 oíclock.
So theyíre going to ask you, ìHow much time was involved for anesthesia?î Itís a longer
window of time.
From the time he walked in and started talking to you to the time he released you to the
recovery room nurse.
If thereís complications after surgery, itís for the anesthesia.
Maybe they have trouble waking you up or something like that.
The physicianís gone.
Itís all the anesthesiologist now.
So you know, he could ultimately spend more time with you and he does spend more time
with you then the op for the doctor.
So keep that in mind, that will be a test question.
Iím sure of it.
And scroll down just a little bit more.
I think thereís one more thing.
Modifying units, this is something else youíre going to see on the CPC exam because itís
just easy to write to test questions and throw these in to make sure you understand what
the modifying units are.
These are add on codes.
And remember, add on codes cannot be used as first listed code.
So when you look at your CPT manual and you see that plus sign, know that cannot be a
first listed diagnosis.
If you see that on your choices, A, B, C, and D and one says, ì99100î and then it
has the anesthesia code, just cross it off.
Itís automatically you knowÖ itís not.
Itís an add on code.
It canít be first.
Okay, what theyíre doing is theyíre saying to the payer and statistic-wise as well, if
an anesthesia is a little more complicated, if the patient is under 1 year old or over
70.
So if you get an op and that person is you know, 80 years old and theyíre doing anesthesia,
youíre going to amend this 99100 at the end as an add on code.
And theyíll put those ages in there.
When you are reading it and youíre doing anesthesia, you see an age listed, thatís
a read flag.
This may have a modifier.
The second one is 99116 ñ complicated by utilization of total body hypothermia.
Now, you think, whatÖ why would a person be hypothermic having surgery?
Well, they actually induce this state.
Itís not like a person fell in a cold lake and you know, you hear they were hypothermic
so thatís why they were able to recover because there were underwater 5 minutes, blah blah
blah.
Thatís not what theyíre talking about.
What theyíre doing is like if they do an open heart surgery on a person, they want
to slow the heart down and theyíre going to put your body in a hypothermic state so
that itÖ you donít have any ischemic damage because of the open heart surgery.
So they will amend this code to the anesthesia, 99116, because if they put you in a hypothermic
state, itís more complicated to do the anesthesia.
He has to take more care with that.
The same thing with 99135.
This is a complication of utilization of controlled hypotension.
Now, you will think, ìWhy would you make somebodyís heart slow down?î Well, itís
because theyíre wanting to not have so much bleeding.
And one of the examples that I had read about was a hip replacement.
If youíve ever seen a procedure with a hip replacement, I mean, itís brutal.
They you know, not only do they slice you open with a very large incision but theyíre
like picking you up and twisting you and pounding with hammers.
I mean, itís justÖ it is.
Itís brutal.
So you think you know, youíre flayed open like that.
Thatís a lot of blood loss potential.
So what they do is they putÖ they give you hypotension.
They slow the heart down, less blood to deal with.
They can get their job done and you donít you know, control your bleeding.
So again, when you slow the heart down, that makes anesthesia a lot harder.
The last one, complicated by emergency conditions is 99140.
Think about this.
When the anesthesiologist comes in and talks to you because youíre going ot have a procedure
done and he says you know, ìSuzy, are you allergic to anything?î You say no.
Or ìHave you ever had anesthesia before?î No. ìDo you have asthma?î All these questions
that he asks you that he wants forewarning of so that he can give you anesthesia and
you know, keep you safe more or less while heísÖ not have any surprises while youíre
under anesthetic.
Well, letís say you have a car wreck and youíve got you know, cardiac tamponade and
they rush you into the OR and youíre unconscious.
And the anesthesiologist isÖ and theyíre going to start anesthesia.
Well, he doesnít know if youíve ever had anesthesia before.
And if youíre allergic to anesthesia you know, heís got to handle that on the fly.
Or say you had throat surgery and itís really hard to actually you know, put aÖ you know,
get the tube down into your throat.
Little things like that that he doesnít have warning for and itís going to make his job
more complicated then youíre going to amend that 99140.
And that explains to the insurance company whyÖ maybe the whole procedure took longer
than it should have normally.
So itís you know, statistical purposes and also, actually, the anesthesiologist gets
paid more money.
So letís see, when coding for anesthesia, the last thing you need to know for the basic
explanation on coding anesthesia is how to look up the codes and itís pretty simple.
Thatís another reason I like anesthesia is letís say you got a tendon repair.
So what you need to know is you look up under anesthesia and where is the repair being done?
Knee and thatís give you the code.
So itís done by anatomic site and then the procedure.
So youíre going to do a septoplasty.
Itís anesthesia of the nose.
Arthroplasty, anesthesia ñ arthroplasty, knee.
Then this last one is just the procedure, C-section or cesarean section and then you
look up anesthesia ñ cesarean delivery.
So once youíve looked up a few anesthesia codes, itís pretty easy.
As long as you know your anatomy and you have to trust the index.
Because if you look up you know, anesthesia of the nose and you donít know thatís where
a septoplastyís done and you go in and you donít see septoplasty listed under 00160,
you have to trust that your index is right and that is of the nose.
So thatís about it.
Thereís a lot more to anesthesia but this is the basics.
This will get you started.