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Some methods of anesthesia



through mouth (general anesthesia)


application to area (injection or topical)


between vertebral spaces


field or nerve block


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


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


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


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


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


normal healthy


mild systemic disease


Severe systemic disease


Severe systemic disease is constant threat to life


Not expected to survive without the operation


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.


anesthesia svcs performed personally by anesthesiologist


medical supervision >4 concurrent procedures


medical direction of 2-4 concurrent procedures


CRNA svc with medical direction


medical direction of 1 CRNA


CRNA svc without medical

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