Anesthesia

Created by mer801 

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Some methods of anesthesia

Endotracheal,local,epidural,regional,MAC,spinal,general

Endotracheal

through mouth (general anesthesia)

Local

application to area (injection or topical)

Epidural

between vertebral spaces

Regional

field or nerve block

MAC

Monitored anesthesia care (service provided by an anesthesiologist or CRNA). Pt is monitored, and if necessary, sedation (including general anesthesia) may be provided.

General

State of unconsciousness accomplished through drug administration or by inhalation

Patient-controlled Analgesia (PCA)

patient self-administers drug. used to relieve chronic pain or temporarily for severe pain following suregery

Moderate (conscious) sedation

No anesthesia personnel are present. Decreased level of consciousness, not reported by physician if provided in nonfacility setting.

Anesthesia Formula

(B+T+M) x conversion factor = anesthesia payment ; Published in Relative value guide (RVG) by amer. society of anesthiologists ; nat'l unit values for anesthesia svcs based on complexity of svc

B

Base units, national unit values for anesthesia services based on complexity of service

T

Time, Pt record indicates time , e.g., 60 minutes. Usually, 15-30 minutes = 1 unit. Some payers may indicate 1 unit = 1 minute. Begins: Anesthesiologist begins to prepare patient for induction- preoperative ; continues through procedure - intraoperative ; ends: pt no longer under care of anesthesiologist - postoperative

M

modifying unit, additional units based on physical status of pt (P1-P6)

Physical status modifiers, P1-P6

located in anesthesia guidelines, not reported to medicare, help to show complexity of service

P1

normal healthy

P2

mild systemic disease

P3

Severe systemic disease

P4

Severe systemic disease is constant threat to life

P5

Not expected to survive without the operation

P6

clinically brain dead

Qualifying circumstances codes

anesthesia svcs provided under difficult circumstances, located in both anesthesia guidelines and medicine section, listed in addition to primary anesthesia code, more than one may be reported

Summing up formula

Base units (from RVG) based on CPT codes, Times units (usually 15-30 minutes is a unit), Total time/30 = time units, modifiers

Conversion factors

CMS anesthesia conversion factors, sum of money allocated by payer, per unit for pymnt of anesthesia svcs

Anesthesia for multiple surgical procedures

once anesthetized, length of time, not number of procedures performed during session. ; report highest relative value guide (RVG) valued CPT code (ex: two procedures during same session : one, 10 units ; the other, 5 units , report only 10 units and combined time for all procedures)

Anesthesia Modifiers

Anesthesia code reported twice : once for anesthesiologist and once for CRNA. ; Each reports svc on separate claim form: one claim anesthesiologist's svc, one claim CRNA's svc ; Anesthesia Modifiers report supervision/direction circumstances; Anesthesia modifier always precedes the physical status modifier.

AA

anesthesia svcs performed personally by anesthesiologist

AD

medical supervision >4 concurrent procedures

QK

medical direction of 2-4 concurrent procedures

QX

CRNA svc with medical direction

QY

medical direction of 1 CRNA

QZ

CRNA svc without medical

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