Anesthesia Coding Guidelines

Services included in anesthesia codes
Interpretation of lab values
Arterial line insertion for blood pressure monitoring
Administration of blood or fluid
Usual monitoring services like temperature, blood pressure, oximetry, ECG,
The usual preoperative and postoperative visits
Capnography and mass spectroectry
Placement of IVs for fluid or medication administration

Services not included in Anesthesia Package
Insertion of Swan-Ganz catheter
Emergency Intubation
Central venous pressure line
Unusual forms of monitoring such as placement of central venous lines
Pain management injections or placement of epidural for postoperative pain management
Critical care visits
Arterial catheter
Transesophageal echocardiography

Anesthesia Modifiers
Physical Status modifiers
P1 - Normal health 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 not expected to survive w/out operation
Medicare does not recognize physical status modifiers.

CPT and HCPCS Modifiers
23 - Unusual anesthesia
32 - Mandated services
AA - Anesthesia performed by the anesthesiologist
AD - Medical supervision by a physician; more than four concurrent anesthesia services
QX - CRNA service with medical direction by a physician
QY - Medical direction of one CRNA by a physician
QZ - CRNA service without medical direction by a physician
QK - Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS - Monitored anesthesia care (an informational modifier, does not affect reimbursement)

Anesthesia time begins when the anesthesiologist begin to prepare the patient for anesthesia. Anesthesia time ends when the anesthesiologist is no longer in personal attendance. Anesthesia time is calculated in intervals of 15 minutes