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31 terms

Anesthesia

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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