vinomodyjr13

1
CANPC Anesthesia and Pain Management

• Vino C. Mody Jr., COC, CPC, CCS-P, CANPC, CCVTC,
  CEDC, 4Med CICP
• Local Chapter AAPC Event
• El Paso, TX

2
Anesthesia

• General endotracheal anesthesia Patient is
  unconscious and has no control of airway airway
  is controlled through intubation
• MAC (Monitored anesthesia care) Patient cannot
  be easily aroused but will respond to painful
  stimuli. Patient is able to control airway
• Regional anesthesia Epidurals and nerve blocks
• Local anesthesia Included in the minor surgery.
  It is not a service performed by the anesthesia
  provider

3
EpiduralInjection of an anesthetic to produce
epidural anesthesia for low back pain,
radiculopathy, or spinal stenosis
4
Case 1

• Anesthesia begin 900
• Anesthesia end 1110 A.M.
• 130 minutes anesthesia time
• ASA Physical status II
• Anesthesiologist D, MD
• CRNA MS, MD
• Dr. D placed an arterial line in the left radial
  artery
• 49 y.o.
• Anesthesia General endotracheal
• There was an emergency condition of bleeding
  during the case

5
Case 1

• A 49 y.o. woman with hypertension undergoes three
  breast biopsies due to suspected breast cancer.
  The pathology report found evidence of ductile
  carcinoma in situ. Staining identified the tissue
  as ER/PR positive and Her 2 negative, based on
  manual morphometric analysis. Based on the
  patients history and pathology results, she is
  assigned as stage 1.
• Diagnoses
• Ductile carcinoma in situ of the breast
• Estrogen receptor (ER) and progesterone receptor
  (PR) positive and Her 2 negative
• ICD-10-CM Diagnosis codes
• Z17.0, D05.10, I10

6
Case 1

• Procedures
• Biopsies, breast, percutaneous, three
• Morphometric analysis, tumor immunohistochemistry
  (e.g. her-2/neu, estrogen receptor/progesterone
  receptor), quantitative or semi-quantitative
• Procedure codes
• 19081, 19082, 19082, 88360 x 3

7
Case 1

• Units calculation
• Crosswalk
• Relative value guide
• UnitsBasetimePSEmergency
• Crosswalk
• 190813 base value units00400
• 19082Not a primary procedure code
• Relative Value Guide
• 00400, 3 base value units
• Units38.700213.7 (Can be 13 or 14 for CANPC
  exam)
• Medicare UnitsBaseTime11.7

8

• Overall anesthesia code for the case for the
  billing anesthesiologist
• 00400-QY-P2, 36620, 99140
• Overall anesthesia code for the case for the
  billing CRNA
• 00400-QX, 99140
• 00400 Anesthesia for procedures on the
  integumentary system on the extremities, anterior
  trunk, and perineum, not otherwise specified
• 36620 Arterial catheterization or cannulation for
  sampling, monitoring or transfusion (separate
  procedure) percutaneous
• 99140 Anesthesia complicated by emergency
  conditions

9
Using the relative value guide

• Physical status modifiers and base unit value
• P1-A normal healthy patient0
• P2-A patient with mild systemic disease0
• P3-A patient with severe systemic disease1
• P4-A patient with severe systemic disease that is
  a constant threat to life2
• P5-A moribund patient who is not expected to
  survive without the operation3
• P6-A declared brain-dead patient whose organs are
  being removed for donor purposes0
• Emergency (Qualifying circumstances), CPT codes
  and base unit value
• 99100 Anesthesia for patient younger than 1 year
  old or over 70 years old1
• 99116 Anesthesia complicated by utilization of
  total body hypothermia5
• 99135 Anesthesia complicated by utilization of
  controlled hypotension5
• 99140 Anesthesia complicated by emergency
  conditions2

10
Determining the anesthesia code

• Determining the anesthesia code for the case
• Look up all of the CPT codes in the ASA Crosswalk
• Determine the corresponding anesthesia code with
  base unit value for each CPT code
• The corresponding anesthesia code with the
  highest base value is the overall anesthesia code
  for the case

11
Case 2

• Diagnosis Lumbago
• Procedure Bilateral lumbar medial branch block
  under fluoroscopy for the L3, L4,L5 medial
  branches for the L4-L5, L5-S1 facets for
  diagnostic and therapeutic purposes
• The procedure involves injection of fluoroscopy
  guided local anesthetic medial branch blocks. A
  nerve block is an injection to prevent normal
  functioning of the nerve in this case, i.e. to
  stop neurogenic lower back pain.
• The imaging guidance is the fluoroscopy which is
  bundled with the nerve block.

12
Case 2

• Diagnosis code
• M54.5 Lumbago or lower back pain
• Procedure codes
• 64493-50, 64494-50
• Injection(s), diagnostic or therapeutic agent,
  paravertebral facet (zygapophyseal) joint (or
  nerves innervating that joint) with image
  guidance (fluoroscopy or CT), lumbar or sacral
  single level
• second level, bilateral
• Global days 000An established patient E/M is
  selected based on the documentation for the
  service