Monitored anesthesia care (service provided by an anesthesiologist or CRNA). Pt is monitored, and if necessary, sedation (including general anesthesia) may be provided.
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.
(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
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
Physical status modifiers, P1-P6
located in anesthesia guidelines, not reported to medicare, help to show complexity of service
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
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 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.