CANPC LECTURE EL PASO, TEXAS AAPC LOCAL CHAPTER, 072020

vinomodyjr

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CANPC Anesthesia and Pain Management
Vino C. Mody Jr., COC, CPC, CCS-P, CANPC, CCVTC, CEDC, COPC, 4Med CICP, RMC, REMS, CMAA, CBCS, Medical coding certification (Expert Level), CNPR, CRMC
Local Chapter AAPC Event
El Paso, TX
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
Epidural
Injection of an anesthetic to produce epidural anesthesia for low back pain, radiculopathy, or spinal stenosis
Case 1
Anesthesia begin 8:00 A.M.
Anesthesia end 11:30 A.M.
210 minutes anesthesia time
ASA Physical status IV
Anesthesiologist DD, MD
CRNA, MZ
45 y.o.
Anesthesia: General endotracheal
Anesthesiologist DD, MD provided the general anesthesia for the case while medically directing one CRNA, MZ
Case 1
A 45 y.o. F patient presents for wide excision of a 2.0 cm malignant melanoma of the left thigh. The area excised resulted in a 4.3 cm X 2.5 cm defect requiring rotational advancement flap closure.
Diagnoses
Malignant melanoma of the left thigh
ICD-10-CM Diagnosis codes
C43.72
Case 1
Procedures
Rotational advancement flap closure with excision of 4.3 cm X 2.5 cm skin defect
Procedure codes
14001
Case 1
Units calculation
Crosswalk
Relative value guide
Units=Base+time+PS+Emergency
Crosswalk
14001=3 base value units=00400
Relative Value Guide
00400, 3 base value units
Units=3+14.0+1+0=18.0
Medicare Units=Base+Time=17.0
Overall anesthesia code for the case for the billing anesthesiologist
00400-QY-P4
Overall anesthesia code for the case for the billing CRNA
00400-QX-P4
00400 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk, and perineum, not otherwise specified
Physical status modifiers and base unit value
P1-A normal healthy patient=0
P2-A patient with mild systemic disease=0
P3-A patient with severe systemic disease=1
P4-A patient with severe systemic disease that is a constant threat to life=2
P5-A moribund patient who is not expected to survive without the operation=3
P6-A declared brain-dead patient whose organs are being removed for donor purposes=0
Emergency (Qualifying circumstances), CPT codes and base unit value
+99100 Anesthesia for patient younger than 1 year old or over 70 years old=1
+99116 Anesthesia complicated by utilization of total body hypothermia=5
+99135 Anesthesia complicated by utilization of controlled hypotension=5
+99140 Anesthesia complicated by emergency conditions=2
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
Case 2
Anesthesia begin 9:00 A.M.
Anesthesia end 10:30 A.M.
90 minutes anesthesia time
ASA Physical status IV
CRNA, JM
80 y.o.
Anesthesia: General endotracheal
CRNA, JM provided the general anesthesia for the case
Case 2
•An 80-year old male patient was taken to the special procedure unit for cystoscopy after developing gross hematuria. The cystoscopy revealed a 2.5 cm tumor in the trigone and a 2.1 cm tumor of the posterior wall. Both tumors were fulgurated. The patient was diagnosed with urothelial cell carcinoma.
Case 2
Diagnosis code
C67.8 Malignant neoplasm of overlapping sites of bladder
Procedure codes
52235 Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
Case 2
•Units calculation=Base+Time+PS+QC=
5+6.0+2+1=14.0
Case 2
Overall anesthesia code for the case for the billing CRNA
00912-QZ-P4, +99100
Anesthesia for transurethral procedures (including urethrocystoscopy); transurethral resection of bladder tumor(s)
•+99100 Anesthesia for patient of extreme age, younger than 1 year and older than 70
 

MKcoder

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Tulsa, OK
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Hi vinomodyjr,
I am planning on taking my anesthesia and pan management certification I need some advice and tips to studying. willing to guide me through?
 
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