Anesthesia Coding Alert

Question: Which physical status modifiers should be used for a patient with severe systemic disease?

Florida Subscriber

Answer: Physical status modifiers identify levels of complexity of the anesthesia services, and are reported in conjunction with anesthesia services codes when appropriate. They are represented by the initial letter “P” followed by the appropriate single digit from 1 to 6.

These six levels are explained in CPT^®’s Anesthesia Guidelines and are consistent with the American Society of Anesthesiologists ranking of patient physical status. They are as follows:

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

In this case, you should include P3 with any supporting documentation of the patient’s systemic disease (such as lupus or diabetes). Some payers allow for additional reimbursement for patients classified as P3, P4, or P5 – but others don’t. Be sure you know each payer’s stance toward P modifier usage and reimbursement.

Also: The American Society of Anesthesiologists added examples to the Physical Status Classification System in the Relative Value Guide. Those will help you understand what types of conditions fall into each category.