Anesthesia Coding — VIDEO

I like doing the anesthesia coding maybe because it’s got… it’s like E&M but it’s smaller. It has its own little area in the CPT book and once you know the basics, you’re good to go. There’s really not that many anesthesia codes when you compare it to the volume of the CPT.

The first thing you need to know, there’s 3 things you basically need to know when you’re doing, again, basic anesthesia coding. You need to know type, the BTM and find the code. So let’s click on the answer here and let’s look at the paper that I worked up. Oh, that’s very tiny. Oh, there we go.

Anesthesia Coding Video

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. There’s endotracheal, epidural, spinal, general, regional, local and then patient-controlled. But really, patient-controlled is a little bit different because that’s when they give you that morphine pump. If you’ve ever had to have that and the patient literally… you know, it’s set up that it can’t be you know, given closer than every 30 minutes and the patient can give them the morphine when they want it so the nurse doesn’t have to keep coming in.

Endotracheal is whatever they put a tube down someone’s throat into the trachea and that’s for any type of procedure that they do where they… you know, when people say, “Well, they put me under.” Or you’re having you know, major surgery, then that’s the type they’re going to do. Also, you’ll have a separate report, an anesthesia report as well as an op report. You don’t want to get those confused. When you do it… wen you do an op report, you’re 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, you’ll also see that the anesthesiologist billed you as well. He’s a physician and he is going to get paid for his services and he writes a separate report.

Let’s see, epidural. You know, a lot of women are familiar with epidurals and that’s what you hear in the movies when the women are pregnant and they scream, “I want my epidural.” And that’s 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 done… it’s not an op report. There is a report given for that as well.

Spinal, a little bit different than epidural. General, this is what somebody… some people get confused about. A general is not the same as when you go in to have like a hip replacement. They’re going to give you the endotracheal anesthesia. But a general is maybe when you’re going in for a colonoscopy or you’re going in to a procedure where they’re not really putting you to sleep per se. They’re 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 it’s not… 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 you’ve 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. That’s a general circle or a wall of anesthetic that numbs that area. But they can also do a block that way. If you are… say you’ve got a large laceration that’s 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 they’re giving you before it can be toxic to the heart because you know, it is you know, numbing you.

So what they’ll do is they’ll say, “Well, I’m just going to give him a block.” 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 you’re familiar with. If you go to the… if you go off to the pharmacy and you just get a topical analgesic that will just numb the skin. You know, when you put… babies are teething and you put that gel. That’s classified as a topical. There’s also… there’s 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, let’s scroll down just a little bit on this page. The next thing we’re going to look at is the BTM. There’s a formula that’s used with anesthesia and this is how they get reimbursed. It’s 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 don’t start it with a 00. They’re at the beginning of your code book. And for each one procedure, they’re given a value. And I can’t remember, it’s like 1 to 20 maybe, I guess. I don’t 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. That’s for a lumbar puncture. Okay so pre… you know, it’s relatively simple procedure for somebody do a lumbar puncture. They’re just you know, sticking a needle in your back.

Okay so… then you go to 00670. That is the code for spine – open surgery on the spine. Now, say they’re going to go in and put plates or rods on your spine because you have scoliosis or something like that. That’s the code for that. That’s a much more detailed procedure. So it gets a 13 when you’re 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 surgery’s going to have a higher base unit value than having your tonsils taken out or you will run situations like “Hey, you have an appendectory and a cholecystectomy.” Well, if they take your gallbladder out and your appendix out at the same time, they probably have… it’s just about the same type of a procedure, same area. They’re… the base value is going to be the same, you know. So it doesn’t matter which one you list first.

So let’s go down… 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 can’t remember, there’s only… 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 you’re reading the op report, it’s going to say you know, procedure for the cholecystectomy started at 9:15 and was completed at 10 o’clock. But the anesthesiologist report is going to say that he met with the patient at 9 o’clock and reviewed allergies you know, and asked questions like, “Have you ever had anesthesia before?”, 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 o’clock to… excuse me, 10:15 whereas the op only went from 9:15 to 10 o’clock. So they’re going to ask you, “How much time was involved for anesthesia?” It’s 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 there’s complications after surgery, it’s for the anesthesia. Maybe they have trouble waking you up or something like that. The physician’s gone. It’s 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. I’m sure of it.

And scroll down just a little bit more. I think there’s one more thing. Modifying units, this is something else you’re going to see on the CPC exam because it’s 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, “99100” and then it has the anesthesia code, just cross it off. It’s automatically you know… it’s not. It’s an add on code. It can’t be first.

Okay, what they’re doing is they’re 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 they’re doing anesthesia, you’re going to amend this 99100 at the end as an add on code. And they’ll put those ages in there. When you are reading it and you’re doing anesthesia, you see an age listed, that’s a read flag. This may have a modifier.

The second one is 99116 – complicated by utilization of total body hypothermia. Now, you think, what… why would a person be hypothermic having surgery? Well, they actually induce this state. It’s not like a person fell in a cold lake and you know, you hear they were hypothermic so that’s why they were able to recover because there were underwater 5 minutes, blah blah blah. That’s not what they’re talking about. What they’re doing is like if they do an open heart surgery on a person, they want to slow the heart down and they’re going to put your body in a hypothermic state so that it… you don’t 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, it’s 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, “Why would you make somebody’s heart slow down?” Well, it’s because they’re wanting to not have so much bleeding. And one of the examples that I had read about was a hip replacement. If you’ve ever seen a procedure with a hip replacement, I mean, it’s brutal. They you know, not only do they slice you open with a very large incision but they’re like picking you up and twisting you and pounding with hammers. I mean, it’s just… it is. It’s brutal. So you think you know, you’re flayed open like that. That’s a lot of blood loss potential. So what they do is they put… they give you hypotension. They slow the heart down, less blood to deal with. They can get their job done and you don’t 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 you’re going ot have a procedure done and he says you know, “Suzy, are you allergic to anything?” You say no. Or “Have you ever had anesthesia before?” No. “Do you have asthma?” 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 he’s… not have any surprises while you’re under anesthetic.

Well, let’s say you have a car wreck and you’ve got you know, cardiac tamponade and they rush you into the OR and you’re unconscious. And the anesthesiologist is… and they’re going to start anesthesia. Well, he doesn’t know if you’ve ever had anesthesia before. And if you’re allergic to anesthesia you know, he’s got to handle that on the fly. Or say you had throat surgery and it’s really hard to actually you know, put a… you know, get the tube down into your throat. Little things like that that he doesn’t have warning for and it’s going to make his job more complicated then you’re going to amend that 99140. And that explains to the insurance company why… maybe the whole procedure took longer than it should have normally. So it’s you know, statistical purposes and also, actually, the anesthesiologist gets paid more money.

So let’s 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 it’s pretty simple. That’s another reason I like anesthesia is let’s 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 that’s give you the code. So it’s done by anatomic site and then the procedure. So you’re going to do a septoplasty. It’s anesthesia of the nose. Arthroplasty, anesthesia – arthroplasty, knee. Then this last one is just the procedure, C-section or cesarean section and then you look up anesthesia – cesarean delivery. So once you’ve looked up a few anesthesia codes, it’s 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 don’t know that’s where a septoplasty’s done and you go in and you don’t see septoplasty listed under 00160, you have to trust that your index is right and that is of the nose.

So that’s about it. There’s a lot more to anesthesia but this is the basics. This will get you started.

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