Coding procedures are an indispensable part of the work of anesthesiologists-practitioners. Codes are used to mark the duration and type of procedure, which will then be forwarded to the insurance company. In this paper, I would like to review two scenarios for anesthesiology procedures and recommend their coding. Consider the first scenario – in an Alabama hospital, a person was anesthetized for an urgent operation to remove a blood clot in the aortic aneurysm cavity. The patient’s emergency complicates the situation since his condition has become very aggravated against the background of thrombosis. The operation is performed urgently immediately after hospitalization. My task is to correctly encode the procedure and count anesthesia base and time units.
To clean up the basic units, it is necessary to define time increments. They will be 15 minutes each. To calculate time units, dividing the declared anesthesia time by the duration of time increment is required. In my case, it is stated that the anesthesia lasted 120 minutes; respectively, the number of time units will be eight. The main code of the procedure will be 00540, and +99140, the qualifying circumstances code, will be added to it (American Society of Anesthesiologists, 2019). In addition, the code will also be assigned a P4 modifier, which means that the patient has an acute disease that is constantly life-threatening. Summing up, one can get the encoding P4 00540 +99140 and the total amount of units in 24. By converting units according to the Alabama index, I will get a total medicare reimbursement value of $508.8.
The second scenario would be anesthesia in an Arizona hospital for an older man aged 71 years to remove inflamed glands. I will carry out all calculations according to the formulas discussed above. The duration of anesthesia was 60 minutes, which means that the number of time units will be four. The procedure code, anesthesia in the salivary gland area, will be 00100 (Anesthesia Business Consultants, n.d.). I will add the code qualifying circumstances + 99100 since the procedure is performed for a person of extreme age, over 70 years old. The physical status modifier will be P1 since the patient does not have chronic diseases and other health complaints. Thus, the code will look like P1 00100+99100, and the total number of units will be ten. I will get a $219.5 medicare reimbursement value by converting them according to the Arizona State index.
References
American Society of Anesthesiologists. (2019). Anesthesia payment basics series 5 qualifying circumstances. American Society of Anesthesiologists. Web.
Anesthesia Business Consultants. (n.d.). List of CPT codes for anesthesia procedures & services, including modifiers. Anesthesia Business Consultants. Web.