the artificially induced loss of feeling and sensation with or without loss of consciousness.
4 kinds of anesthesia administration
2. Regional anesthesia
Produces a state of unconsciousness. It may be borought about by inhalation of gases such as ether, nitrous oxide and ethylene or by drugs administered intravenously; such as sodium pentothal.
Most major operations are performed under general anesthesia:
The administration of general anesthesia in a doctor's or dentist's office
is considered very dangerous, although some specialists do so routinely.
Loss of sensation of a part of the body due to the interruption of nerve conduction.
This method is adequate for many operations and is considerably less dangerous than general anesthesia.
Applied directly to the surface of the area to be anesthetized. the conjuctive and mucous membranes of the mouth, throat,urethra and bladder are examples of areas taht most effectively anesthestized by a topical application.
Affects only a localized area. Only short procedures can be performed painlessly. Superficial biopsies, mole excisions and suturing of lacerations are the most common procedures perfromed with local anesthesia.
Nerve block anesthesia
Drug injected close to the nerve so that the nerve impulses are interrupted, thereby producing a loss of sensation.
refers to nerves blocked in the subarachnoid space.
refers to the nerves blocked in the epidural space. Epidural anesthesia is frequently used for maternity claims.
spinal anesthetic. Named because the injection produces a loss of feeling in the region of the body that corresponds to the area that mkes contact with riding saddle .
Intravenous (IV) sedation
a medication composed of a sedative and a painkiller administered intravenously. A semiconscious state is produced.
A common mixture ois mepridine (Demerol) and diazepam (Valium).
This type of anesthesia is often used in dental surgical procedures and in many diagnostic procedures such as bronchoscopy and esophagogastro-duodenoscopy.
The coding for anesthesia depends
on the area of the body being operated on.
An anesthesiologist may be classified as either:
Hospital staff anesthesiologis(employed by the hospital)
Independent anesthesiologis (self-employed or not employed by the hospital)
Charges made by a hospital for the services of a staff anesthesiologist are
usually covered as a hospital ancillary expense.
Charges by an outside anesthesiologist very according to plan provision,
but are usually covered under either a separate Basic anesthesia benefit or under a Major Medical benefit. When processing claims, do not confuse the professional anesthesia expense with the charges that may appear on a hospital bill.
Local anesthesia is never allowable separately.
Therefore anesthesia benefits are those that are allowed on procedures that require more than a local anesthesia.
These units (for all schedules) are used when:
*The anesthesia is personally administered by a licensed physician
*The physician remains in constant attendance during the procedure for the sole purpose of administering and monitoring the anesthesia service.
Basic or base anesthesia units are designed to
allow for the usual pre and postoperative care ,the administration of anesthesia and the administration of fluids or blood incident to the anesthesia or surgery.
Usually monitoring services such as
ECG, blood pressure oximetry, capnography, mass spectrometry, and monitoring of blood gases are also included in the basic value and should not be billed separately
The length of time that a person is under anesthesia
determines the amount of money that will be considered allowable for the procedure.
There are two ways of calculating the anesthesia time depending on individual payer guidelines:
1. Actual Time
2. Block Time
Some carriers allow one time unit for each fifteen minutes, regardless of the amount of time a patient is under anesthesia.Any fractional portions of a fifteen minute block (ie 5min) are calculated to the nearest tenth of time. Each 1.5 minutes is worth 0.1 units.
For the first four hours, time units are computed by allowing 1.0 time unit for each 15 minutes. Or if less than 15 minutes.
By adding the basic units to the time units and multiplying that amount by the conversion factor. This procedure applies to all schedules:
The basic units for the MAJOR procedure are the only basic units allowed.
Carriers which pay different percentages for network and non network providers will often pay the anesthesiaologist at the network rate if the chosed surgeon is a network provider, regardless of whether the anesthiesiologist is a part of the their network or not.
denote who performed the services,some carriers use addiotional modifiers for anesthesia services.
Many anesthesia services are proveded under particulary difficult circumstances, depending on factors such as extraordinary conditions of the patient, notable operative conditions and unusual risk factors.
Monitored anesthesia care
the monitoring of a patient's vital sign during an operation in anticipation of the need for general anesthesia.
In order for MAC to be reimbursed
the anesthesiologist must be present during the entire operative procedure.
Patient Controlled anesthesia
Some conditions allow the patient to administer their own pain medication. Usually done thru an infusion pump.
Machine which contains medication and administers a small dose when a button is pushed.
There is almost always an anesthesia charge when major surgery is performed
The claims examiner is responsible for processing these charges.
(*)For Unusual Services or Circumstances
Modifiers -22 or -23 will indicate that unusual procedures were performed.
(*)Modifier QS will denote
that the claim is for MAC services.