November 9, 2024

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The Techno Universe

CPT Codes Lookup: Anesthesia Coding Leaving You Benumbed? Here’s Help

If you’re confused about when you should report conscious sedation and anesthesia in the emergency department (ED), here are some expert tips to help you stay awake and alert on how – and how not – to report the anesthesia services.

When your physician administers conscious sedation for another physician who’s performing the surgery, you should report the CPT codes for anesthesia and not the conscious -sedation codes. Always ask your physician for a copy of the flow sheet, which will contain all records of the medications the physician administered to the patient, updates of the patient’s vital-signs, and the number of times he performed each of these.

When billing anesthesia, you must remember to find out the appropriate anesthesia base units for the surgical procedure and then add the time units. Here’s a quick, three-step procedure to help you report anesthesia services accurately and correctly:

1. Your CPT code lookup will show you a number of options. While you may have to report more than one CPT code, you should take the dominant CPT code (the one code that represents the surgical procedure that your physician performed), and then based on that code you should determine the appropriate anesthesia code from the section 00100-01999.

2. Further going by the ASA guidelines determine the number of base units assigned to that particular anesthesia code.

3. Add in the time units reflected in the record, based on your payer’s increments.

In addition, when reporting the anesthesia codes, you may be required to apply one of the following patient status modifiers. Ask your physician to document the patient’s condition in the record so you’ll have a better idea about which modifier to choose:

  • P1 – Normal healthy patient
  • P2 – Patient with mild systemic disease
  • P3 – Patient with severe systemic disease
  • P4 – Patient with severe systemic disease that is a constant threat to life
  • P5 – Moribund patient who is not expected to survive without the operation
  • P6 – Declared brain-dead patient whose organs are being removed for donor purposes

Note: These modifiers are applicable only to the anesthesia codes – not to conscious codes. Remember these guidelines when reporting conscious sedations codes:

1. Conscious sedations codes are not limited to being reported with any other specific CPT code.

2. You should not report pulse oximetry separately from conscious sedation codes.

3. You should not report conscious sedations along with anesthesia.

4. Conscious sedations codes require the presence of a trained observer during the procedure. Check your documentation to know if there was someone observing.

5. Demerol and morphine, used individually, generally do not constitute conscious however the physician may apply them in addition to higher-level agents such as midazolam or ketamine.

6. For codes whose descriptions contains words like “with” or “without anesthesia,” report “without anesthesia” during conscious- sedation procedures.

7. You must never append the modifier -47 (Anesthesia by surgeon) when reporting any of the sedation codes.