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2007–PMCC

Anesthesia

Chapter182007–PMCC

Anesthesia

Chapte1ChapterOutlineIntroducestudentstoFormsofanesthesiaAnesthesiaguidelinesAnesthesiamodifiersChapterOutlineIntroducestud2AnesthesiaGuidelinesAnesthesiaserviceincludesUsualpreoperativeandpostoperativevisitsAdministrationoftheanestheticforthesiteofsurgeryAnesthesiacareduringtheprocedureAdministrationoffluidsand/orbloodreplacementInterpretationofnoninvasivemonitoring(bloodpressure,ECG,temperature,oximetry,apnography,andmassspectrometry)TimeKeyelementforreimbursementStartswhenanesthesiologistbeginspreparingpatientinOREndswhenanesthesiologistnolongerinpersonalattendanceandpatientissafelyplacedunderpostoperativesupervisionAnesthesiaGuidelinesAnesthesi3【高血壓英文課件】-Anesthesia4【高血壓英文課件】-Anesthesia5AnesthesiaModifiersThreesetsofmodifierstoconsiderPhysicalstatusHCPCSCPTCPTmanualalsoincludescodesforReportingcircumstancesthatcouldincreasethedifficultyofprovidinganesthesiaAnesthesiaModifiersThreesets6PhysicalStatusModifiersP1—Normal,healthypatientP2—Patientwithmildsystemicdisease(eg,mild,benign,hypertensiveheartdisease)wellcontrolledonmedicationP3—Patientwithseveresystemicdisease(eg,benign,hypertensiveheartandrenaldiseasewithcongestiveheartandrenalfailure)P4—Patientwithseveresystemicdiseasethatisaconstantthreattolife(eg,hypertrophicobstetriccardiomyopathywithESRD)awaitinghearttransplantP5–MoribundpatientwhoisnotexpectedtosurvivewithoutsurgeryP6—AdeclaredbraindeadpatientwhoseorgansarebeingremovedfordonorpurposesPhysicalStatusModifiersP1—No7CPTModifiers22—UnusualProceduralServices23—UnusualAnesthesia(Identifiesaprocedurethatusuallyrequiresnoanesthesiaorlocalanesthesia.Underunusualcircumstances,generalanesthesiaisrequired)32—MandatedServices51—MultipleServices53—DiscontinuedProcedure59—DistinctProceduralService(Identifiescertaincircumstanceswhenaphysicianmayneedtoindicatethataprocedure/servicewasdistinctorindependentfromotherservicesperformedonthesameday)CPTModifiers22—UnusualProced8HCPCSLevelIIModifiersAA—AnesthesiaserviceperformedpersonallybyanesthesiologistAD—Medicalsupervisionbyaphysician:morethanfourconcurrentanesthesiaproceduresG8—Monitoredanesthesiacare(MAC)fordeepcomplex,complicated,ormarkedlyinvasivesurgicalprocedureG9—MonitoredanesthesiacareforpatientwhohashistoryofseverecardiopulmonaryconditionQB—PhysicianprovidingserviceinaruralHPSAQK—Medicaldirectionoftwo,three,orfourconcurrentanesthesiaproceduresinvolvingqualifiedindividualsQS—Monitoredanesthesiacareservice(MAC)QX—Certifiedregisterednurseanesthetist(CRNA)service,withmedicaldirectionbyaphysicianQY—Medicaldirectionofonecertifiedregisterednurseanesthetist(CRNA)byananesthesiologistQZ—CRNAservice,withoutmedicaldirectionbyaphysicianHCPCSLevelIIModifiersAA—Ane9TypesofAnesthesiaGeneralAnesthesiaResultsinlossofconsciousnessProducesamnesiabyblockingtheawarenesscenterinthebrainCPTcodes00100-01999representgeneralanesthesiaunlesscodedescriptionstatesotherwiseRegionalAnesthesiaBlocksallpainfulsensationtothespecificregionofthebodyinnervatedbythenerveornerveplexusreceivingtheanestheticDoesnotinduceunconsciousnessTypesofAnesthesiaGeneralAne10TypesofAnesthesiaPeripheralNerveBlocksAnesthetizeindividualnervesornerveplexusesAnestheticagentinjectedalongthenerveratherthaninthenerveCodes64400-64530UsedtodescribetheseservicesNerveBlocksAnesthetizeentireregionsSpinalAnesthesiaUsedformajorproceduresperformedbelowlevelofthediaphragmRelativelysafeProvidesexcellentmusclerelaxationAccomplishedbyplacingneedlebetweenthevertebraeandinjectinganestheticagentintothesubarachnoidspaceFrequentlyusedforpainmanagementbyanesthesiologistsTypesofAnesthesiaPeripheral11TypesofAnesthesiaEpiduralAnesthesiaAchievedbyinjectinganestheticagentintoepiduralspaceofthoracicorlumbarinterspacesUsuallyavoidpostoperativeheadachesIntravenousRegionalBlocksUsedforsomeproceduresonextremitiesPneumatictourniquetappliedtothelimbandanestheticagentisinjectedintotheveinofthelimbdistaltothetourniquetFieldBlockUsedtoformbarrierbetweenoperativesiteandnervoussystemAccomplishedbymultipleinjectionsoflocalanestheticagentLocalAnesthesiaAppliedtopicallyorbylocalinfiltrationTypesofAnesthesiaEpiduralAn12PainManagementBenefitsofproperpainmanagementShorterhospitalstaysIncreasedmobilizationAcutePainMaybeexperiencedduringpostoperativeperiodIncludedinsurgeon’sfeeShouldonlybeturnedovertoaspecialistwhenspecialcircumstanceswarrantthislevelofserviceDocumentationmustexistwithinmedicalrecordtoindicatewhyservicesofanesthesiologistareneededPainManagementBenefitsofpro13PainManagementPainmanagementoptionsmayincludeCognitive,behavioralinterventionssuchaseducation,relaxation,distraction,biofeedbackSystemicadministrationofanonsteroidalanti-inflammatorydrugs(NSAID)oropiatesPatientcontrolledanalgesia(PCA)SpinalanalgesiaIntermittentorcontinuousnerveblockPhysicalagents(eg,massage)applicationofheatorcoldmodalitiesTranscutaneouselectricalnervestimulator(TENS)ChronicPainPainthatdoesnotresolveitselfafter3-6monthsTreatedbyvarietyofmodalitiesPainManagementPainmanagement14MonitoredAnesthesiaCare(MAC)Attimes,ananesthesiologistmaybecalledupontoProvidespecificanesthesiaservicestoapatientundergoingplannedprocedure,whenpatientmayreceivelocalornoanesthesiaatallMACshouldbereportedbyusingModifierQSDocumentationformedicalnecessityShouldbeevidentinpatient’srecordMedicareWantsmodifierG8orG9tobereported,ifapplicableMonitoredAnesthesiaCare(MAC15ProceduralCodingSpineandSpinalCord(00600-00670)Newcodesfor200700625Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;notutilizingonelungventilation00626Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;utilizingonelungventilationProceduralCodingSpineandSpi16ProceduralCodingKneeandPoplitealArea(01320-01444)RegionalanesthesiaforkneesurgeryhasthreeseparatestepsEpidural/spinalanesthesiapainduringthesurgeryFemoralnerveblockhelpstomanagepainafterthesurgerySedationduringsurgeryLowerLeg(BelowKnee,IncludesAnkleandFoot)(01462-01522)SciaticnerveusedtonumbonlythelegandfootscheduledforsurgeryOtherlegnotaffectedWhenneedleisclosetocorrectposition,patient’sfootwillmoveonitsownOnceneedleinproperposition,nerveblockmedicineisinjectedProceduralCodingKneeandPopl17ProceduralCodingShoulderandAxilla(01610-01682)NervesofshouldandarmLocatedonsideoftheneck,justabovecollarboneSingleinjectionintonerveswillnumbshoulderfor12-24hoursNumbingaffectsonlythesidescheduledforsurgeryRadiologicalProcedures(01905-01933)Interventionalradiologyusingfluoroscopy,ultrasound,CTandMRIOftenperformedunderlocalanesthesiawithIVsedationGeneralanesthesiamaybeprovidedtopatientswhohavehaddifficultywithsedation,orhavecoexistingmedicalconditionsProceduralCodingShoulderand18ProceduralCodingBurnExcisionsorDebridement(01951-01953)LocalorgeneralanesthesiaMaybeusedwhensurgicallydebridingburnsTip:BurnsintheOR—mostburns(58%)intheORarefromdevicesusedtowarmthepatient,includingIVbagsandwarmingdevices,cauterydevicescausedfromburnseitherbygroundingpadsorbycausingafire.MiscellaneousdevicesassociatedwithburnsincludedMRI,retractors,defibrillatorpaddles,andECGleads.ProceduralCodingBurnExcision19ProceduralCodingObstetricalAnesthesia(01958-01969)SeveraldifferentformsofanesthesiaadministeredforchildbirthMaybeusedindependentlyorinconjunctionwithoneanotherMostcommonlyadministeredLocalRegionalProceduralCodingObstetricalA20QualifyingCircumstancesAnesthesiologistsandCRNAsshouldusetheseadd-oncodestoreportSituationsthatmakeadministeringanesthesiaparticularlydifficultMedicaredoesnotpayforthefollowingadd-onservices+99100—Anesthesiaforapatientofextremeage,underoneyearorover70+99116—Anesthesiacomplicatedbyutilizationoftotalbodyhypothermia+99135—Anesthesiacomplicatedbyutilizationofcontrolledhypotension+99140—

Anesthesiacomplicatedbyemergencyconditions(specify)QualifyingCircumstancesAnesth21ModerateConsciousSedation(99143-99150)LocatedintheMedicineSectionofCPTDruginduceddepressionofconsciousnessAllowspatienttoRespondpurposefullytoverbalcommands,eitheraloneoraccompaniedbylighttactilestimulationMaybeadministeredinHospitalsOutpatientfacilitiesModerateConsciousSedation(922ModerateConsciousSedation(99143-99150)ServicesthatareincludedinmoderateconscioussedationAssessmentofpatient(notincludedinintraservicetime)EstablishmentofIVaccessandfluidstomaintainpatency,whenperformedAdministrationofagent(s)MaintenanceofsedationMonitoringofoxygensaturation,heartrate,andbloodpressureRecovery(notincludedinintraservicetime)Code99143—clarifiesuseofmoderateconscioussedationservices;sedationprovidedbysamephysicianperformingthediagnostic/therapeuticservice,youngerthan5yearsofage,first30minutesofintraservicetimeCodes99144and99145—furtherclarifyageandtimeconstraintsCode99148—clarifiesuseofasecondprovider;underage5yearsofage,first30minutesintraservicetimeModerateConsciousSedation(923AnesthesiaCrosswalkAnesthesiacodesDonotoftencorrespondonaone-to-onebasiswithsurgerycodesApproximately40,000Surgical,medicalandradiologicalproceduresrepresentedbynearly260anesthesiacodesAnesthesiacodesArrangedbasedonanatomicalareasImportanttoutilizeacrosswalksuchasASACrosswalk–AGuideforSurgery/AnesthesiaCPTCodesAnesthesiaCrosswalkAnesthesia24TheEndTheEnd252007–PMCC

Anesthesia

Chapter182007–PMCC

Anesthesia

Chapte26ChapterOutlineIntroducestudentstoFormsofanesthesiaAnesthesiaguidelinesAnesthesiamodifiersChapterOutlineIntroducestud27AnesthesiaGuidelinesAnesthesiaserviceincludesUsualpreoperativeandpostoperativevisitsAdministrationoftheanestheticforthesiteofsurgeryAnesthesiacareduringtheprocedureAdministrationoffluidsand/orbloodreplacementInterpretationofnoninvasivemonitoring(bloodpressure,ECG,temperature,oximetry,apnography,andmassspectrometry)TimeKeyelementforreimbursementStartswhenanesthesiologistbeginspreparingpatientinOREndswhenanesthesiologistnolongerinpersonalattendanceandpatientissafelyplacedunderpostoperativesupervisionAnesthesiaGuidelinesAnesthesi28【高血壓英文課件】-Anesthesia29【高血壓英文課件】-Anesthesia30AnesthesiaModifiersThreesetsofmodifierstoconsiderPhysicalstatusHCPCSCPTCPTmanualalsoincludescodesforReportingcircumstancesthatcouldincreasethedifficultyofprovidinganesthesiaAnesthesiaModifiersThreesets31PhysicalStatusModifiersP1—Normal,healthypatientP2—Patientwithmildsystemicdisease(eg,mild,benign,hypertensiveheartdisease)wellcontrolledonmedicationP3—Patientwithseveresystemicdisease(eg,benign,hypertensiveheartandrenaldiseasewithcongestiveheartandrenalfailure)P4—Patientwithseveresystemicdiseasethatisaconstantthreattolife(eg,hypertrophicobstetriccardiomyopathywithESRD)awaitinghearttransplantP5–MoribundpatientwhoisnotexpectedtosurvivewithoutsurgeryP6—AdeclaredbraindeadpatientwhoseorgansarebeingremovedfordonorpurposesPhysicalStatusModifiersP1—No32CPTModifiers22—UnusualProceduralServices23—UnusualAnesthesia(Identifiesaprocedurethatusuallyrequiresnoanesthesiaorlocalanesthesia.Underunusualcircumstances,generalanesthesiaisrequired)32—MandatedServices51—MultipleServices53—DiscontinuedProcedure59—DistinctProceduralService(Identifiescertaincircumstanceswhenaphysicianmayneedtoindicatethataprocedure/servicewasdistinctorindependentfromotherservicesperformedonthesameday)CPTModifiers22—UnusualProced33HCPCSLevelIIModifiersAA—AnesthesiaserviceperformedpersonallybyanesthesiologistAD—Medicalsupervisionbyaphysician:morethanfourconcurrentanesthesiaproceduresG8—Monitoredanesthesiacare(MAC)fordeepcomplex,complicated,ormarkedlyinvasivesurgicalprocedureG9—MonitoredanesthesiacareforpatientwhohashistoryofseverecardiopulmonaryconditionQB—PhysicianprovidingserviceinaruralHPSAQK—Medicaldirectionoftwo,three,orfourconcurrentanesthesiaproceduresinvolvingqualifiedindividualsQS—Monitoredanesthesiacareservice(MAC)QX—Certifiedregisterednurseanesthetist(CRNA)service,withmedicaldirectionbyaphysicianQY—Medicaldirectionofonecertifiedregisterednurseanesthetist(CRNA)byananesthesiologistQZ—CRNAservice,withoutmedicaldirectionbyaphysicianHCPCSLevelIIModifiersAA—Ane34TypesofAnesthesiaGeneralAnesthesiaResultsinlossofconsciousnessProducesamnesiabyblockingtheawarenesscenterinthebrainCPTcodes00100-01999representgeneralanesthesiaunlesscodedescriptionstatesotherwiseRegionalAnesthesiaBlocksallpainfulsensationtothespecificregionofthebodyinnervatedbythenerveornerveplexusreceivingtheanestheticDoesnotinduceunconsciousnessTypesofAnesthesiaGeneralAne35TypesofAnesthesiaPeripheralNerveBlocksAnesthetizeindividualnervesornerveplexusesAnestheticagentinjectedalongthenerveratherthaninthenerveCodes64400-64530UsedtodescribetheseservicesNerveBlocksAnesthetizeentireregionsSpinalAnesthesiaUsedformajorproceduresperformedbelowlevelofthediaphragmRelativelysafeProvidesexcellentmusclerelaxationAccomplishedbyplacingneedlebetweenthevertebraeandinjectinganestheticagentintothesubarachnoidspaceFrequentlyusedforpainmanagementbyanesthesiologistsTypesofAnesthesiaPeripheral36TypesofAnesthesiaEpiduralAnesthesiaAchievedbyinjectinganestheticagentintoepiduralspaceofthoracicorlumbarinterspacesUsuallyavoidpostoperativeheadachesIntravenousRegionalBlocksUsedforsomeproceduresonextremitiesPneumatictourniquetappliedtothelimbandanestheticagentisinjectedintotheveinofthelimbdistaltothetourniquetFieldBlockUsedtoformbarrierbetweenoperativesiteandnervoussystemAccomplishedbymultipleinjectionsoflocalanestheticagentLocalAnesthesiaAppliedtopicallyorbylocalinfiltrationTypesofAnesthesiaEpiduralAn37PainManagementBenefitsofproperpainmanagementShorterhospitalstaysIncreasedmobilizationAcutePainMaybeexperiencedduringpostoperativeperiodIncludedinsurgeon’sfeeShouldonlybeturnedovertoaspecialistwhenspecialcircumstanceswarrantthislevelofserviceDocumentationmustexistwithinmedicalrecordtoindicatewhyservicesofanesthesiologistareneededPainManagementBenefitsofpro38PainManagementPainmanagementoptionsmayincludeCognitive,behavioralinterventionssuchaseducation,relaxation,distraction,biofeedbackSystemicadministrationofanonsteroidalanti-inflammatorydrugs(NSAID)oropiatesPatientcontrolledanalgesia(PCA)SpinalanalgesiaIntermittentorcontinuousnerveblockPhysicalagents(eg,massage)applicationofheatorcoldmodalitiesTranscutaneouselectricalnervestimulator(TENS)ChronicPainPainthatdoesnotresolveitselfafter3-6monthsTreatedbyvarietyofmodalitiesPainManagementPainmanagement39MonitoredAnesthesiaCare(MAC)Attimes,ananesthesiologistmaybecalledupontoProvidespecificanesthesiaservicestoapatientundergoingplannedprocedure,whenpatientmayreceivelocalornoanesthesiaatallMACshouldbereportedbyusingModifierQSDocumentationformedicalnecessityShouldbeevidentinpatient’srecordMedicareWantsmodifierG8orG9tobereported,ifapplicableMonitoredAnesthesiaCare(MAC40ProceduralCodingSpineandSpinalCord(00600-00670)Newcodesfor200700625Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;notutilizingonelungventilation00626Anesthesiaforproceduresonthethoracicspineandcord,viaananteriortransthoracicapproach;utilizingonelungventilationProceduralCodingSpineandSpi41ProceduralCodingKneeandPoplitealArea(01320-01444)RegionalanesthesiaforkneesurgeryhasthreeseparatestepsEpidural/spinalanesthesiapainduringthesurgeryFemoralnerveblockhelpstomanagepainafterthesurgerySedationduringsurgeryLowerLeg(BelowKnee,IncludesAnkleandFoot)(01462-01522)SciaticnerveusedtonumbonlythelegandfootscheduledforsurgeryOtherlegnotaffectedWhenneedleisclosetocorrectposition,patient’sfootwillmoveonitsownOnceneedleinproperposition,nerveblockmedicineisinjectedProceduralCodingKneeandPopl42ProceduralCodingShoulderandAxilla(01610-01682)NervesofshouldandarmLocatedonsideoftheneck,justabovecollarboneSingleinjectionintonerveswillnumbshoulderfor12-24hoursNumbingaffectsonlythesidescheduledforsurgeryRadiologicalProcedures(01905-01933)Interventionalradiologyusingfluoroscopy,ultrasound,CTandMRIOftenperformedunderlocalanesthesiawithIVsedationGeneralanesthesiamaybeprovidedtopatientswhohavehaddifficultywithsedation,orhavecoexistingmedicalconditionsProceduralCodingShoulderand43ProceduralCodingBurnExcisionsorDebridement(01951-01953)LocalorgeneralanesthesiaMaybeusedwhensurgicallydebridingburnsTip:BurnsintheOR—mostburns(58%)intheORarefromdevicesusedtowarmthepatient,includingIVbagsandwarmingdevices,cauterydevicescausedfromburnseitherbygroundingpadsorbycausingafire.MiscellaneousdevicesassociatedwithburnsincludedMRI,retractors,defibrillatorpaddles,andECGleads.ProceduralCodingBurnExcision44ProceduralCodingObstetricalAnesthesia(01958-01969)SeveraldifferentformsofanesthesiaadministeredforchildbirthMaybeusedindependentlyorinconjunctionwithoneanotherMostcommonlyadministeredLocalRegionalProceduralCodingObstetricalA

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