Medical Coding 1 CH 3-Combo

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Anesthesia

Induction or administration of a drug to obtain partial or complete loss of sensation.

Analgesia

Absence of pain

Types of anesthesia

General, Regional, Local or moderate (conscious) sedation.

Endotracheal anesthesia

Inserting a tube into the nose or mouth and passing the tube into the trachea for ventilation.

Epidural anesthesia

Injection of an anesthetic agent into the epidural spaces between the vertebrae, AKA peridural anesthesia, epidural, epidural block, and intraspinal anesthesia.

Spinal anesthesia

All anesthesia procedures applied in the spinal cord area, outside of or inside of the dura mater.

General anesthesia

State of unconsciousness accomplished by the use of drug administered by inhalation, intramuscularly, rectally, or intravenously.

Regional anesthesia

Used to interrupt the sensory nerve conductivity in a region f the body and id produced by a field block (forming a wall of anesthesia around the site by means of local injections) or nerve block (injection of area close to the site).

Blood patch

Not anesthesia, but a procedure. Cerebrospinal fluid leak is closed by means of an injection of the patient's blood into the area that was used during spinal anesthesia.

Local anesthesia

Application of topical agent (lidocaine) or subcutaneous injection .

Patient-controlled analgesia

Allows patient to administer an analgesic drug such as morphine.

Prep\operative, intraoperative (care during surgery) and postoperative care are included in the CPT code. (T/F)

True

If the anesthesiologist provides care that is unusual or beyond that which would usually be provided, services can be reported how?

Reported in addition to the base anesthesia service. A swan-Ganz catheter is not a normal provided service, so would be reported using a code from the Medicine section for placement of the catheter and reporting of the insertion time would result in additional payment.

Anesthesia formula

Base units+time units+modifying units (B+T+M) x conversion factor.

RVG

Relative value guide published by ASA (American Society of Anesthesiologists). Contains codes for anesthesia services.

Base unit value (accepted standard in the United States)

Developed by a team of physicians with expertise in anesthesiology to compare and assign numerical values to each service. CMS publishes this annually.

Anesthesia services are provided based on time during which the anesthesia was administered, in total minutes. When does timing begin and end?

Started when the anesthesiologist begins preparing patient to receive anesthesia, through the procedure and ends when patient is no longer under the personal care of the anesthesiologist. Carriers independently determine the amount of time in a unit.

2 basic modifying characteristics

Qualifying circumstances and physical status modifiers

Adjunct codes

Used under qualifying circumstances, begin with 99 and cannot be used along but must be used in addition to another code (anesthesia) and are used to provide additional information only. Qualifying circumstances codes are located in the Medicine section and the Anesthesia section guidelines.

Physical status modifier, used after the CPT code.

2nd type of modifying unit, used to report the patient's condition at the time anesthesia was administered. Also services to identify the level of complexity of the services provided to the patient. Not assigned by the coder, but determined by the anesthesiologist and document in the anesthesia record.

Conversion factor

Dollar value of each unit. Each 3rd party payer issues a list of conversion factors which varies from one region to another. This is multiplied by the number of units in the procedure.

Concurrent care modifiers

Additional modifiers to indicate how many cases and anesthesiologist is performing or supervising at one time.

Medical direction

The physician is present at the induction and emergence from anesthesia and is immediately available in case of emergency. If a Medicare patient and medical direction occurs, certain documentation must be submitted that supports certain services were personally performed by the physician.

Modifier used to report service where patient is returned to the operating room on the same day for the same or a related procedure, and the same physician is performing the 2nd procedure.

76

Modifier 22 falls under close documentation scrutiny as there is a payment increase of 20-30%. (T/F)

True- if received by a 3rd party payer, the claim is sent to an individual who reviews the claim.

3 significant times when multiple procedure are coded

Same operation, different site; multiple operations, same operative session; procedure performed multiple times.

When coding with modifier -51 in what format should the codes be listed?

First code listed (without) the modifier should be the most resource-intensive (expensive). Subsequent codes should have the modifier, listed in order of complexity from most to least. The primary (first) code would be paid at full or 100%, the second at 50% and 3rd at 24% of the fee.

How would you code the same procedure performed multiple times?

The code by the number of units (25664 x 2) or list the procedure code once w/out -51 modifier and the same code again with a modifier. 26664, 25664-51. Look for the word "each" in the code description as a hint to use the times symbol.

For all Medicare claims, digit specific modifiers must be used for procedures on the hands and feet. (T/F)

True

Moderate conscious sedation codes are located in what section of the CPT manual?

Medicine

Where in CPT is much of the information regarding what is included in an anesthesia service located?

Anesthesia guidelines

Anesthesia services are based on ______ time the patient is under the anesthesiologists care.

Total (calculation of units of time is determined by the 3rd party payer)

Anesthesia time begins when the anesthesiologist _______, continues _______ the procedure, and ends when ____________.

Prepares the patient to receive anesthesia; throughout; patient is no longer under the personal care of the anesthesiologist.

According to the Anesthesia Guidelines, what is the one modifier that is not used with anesthesia procedures?

47

"P1" is an example of what type of modifier?

Physical status

What word means "in a dying state"

Moribund

What word means "affecting the body as a whole"

Systemic

What type of circumstance identifies a component of anesthesia service that affects the character of the service?

Qualifying

Anesthesia procedures are divided by what type of site?

Anatomic

When several physicians, with technicians and specialized equipment, work together to complete a complicated procedure and each physician has a specific p[portion f the surgery to compete, they are termed what?

Surgical Team

Is it true that a physician who personally administers the anesthesia to the patient upon whom he or she is operating cannot bill the patient?

No

Name of the guide published by the American Society of Anesthesiologists and provides the weights of various anesthesia services.

RVG (Relative Value Guide)

2 words that describe a decreased level of consciousness that does not put patients completely to sleep & that allows the patients to breathe on their own during a surgical procedure

Moderate conscious

CRNA stands for what?

Certified Registered Nurse Anesthetist

Appendix in the CPT manual that contains a complete list of all modifiers

A

Word that means assigning multiple codes when one code would do

Unbundling (considered fraud)

Term that describes the services provided to a patient by the physician before surgery

Preoperative

Term for the time after the surgery that the physician provides services to the patient

Postoperative

Term for the time during surgery that the physician provides services to the patient

Intrasurgery

Do all 3rd party payers recognize all modifiers as listed in the CPT manual?

No

Term that describes 2 physicians working together in the completion of a procedure when each has the same level of responsibility

Co-surgeons

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