Anesthesia Basic coding Guidelines Part A

Ancillary Services : Introduction.

Ancillary services refer to the health care services provided exclusive of room and board. Supplies and laboratory tests provided under home care, audiology, durable medical equipment (DME), ambulatory surgical centers (ASC), home infusion, hospice care, skilled nursing facility (SNF), cardiac testing, mobile lithotripsy, fitness center, radiology, pulmonary testing, sleep centers, and kidney dialysis are examples of ancillary services. Without ancillary services doctors, dentists and nurses will not be able to function effectively. In short we might say that ancillary services are services performed by Anesthesia staff (since we only bill for Anesthesiologist/CRNA) other than the main anesthesia service.

Examples of ancillary services mostly encountered in Anesthesia coding are:

Block
Lines (IV/CVP/PA cath/Art-line)
Echo/TEE

Key Identifiers:

• Blocks Used for Surgical Anesthesia are not reported separately (because it is the TOA). Block administered by Anesthesia staff, for Post op pain purpose are reported separately.
• Blocks are mostly encountered in cases like ORIF, other procedures on joints/arthroscopies, often encountered with circulatory system procedures (carotid endarterectomy), laparotomies, nephrectomy, etc. [These procedure names are mere examples. There are no blanket rules in coding, it varies from chart to chart basis.]
• Lines could be divided in to IV/Art-line/ CVP or PA
• IV lines are to be reported whenever performed by Anesthesia staff, and difficult access/Multiple attempt are documented.
• Arterial line or Art line/A-line are mostly reported only when performed by anesthesia staff.
• A-line are mosty encountered in : Procedure on arteries (endarterectomies, bypass graft etc), procedure on brain, spinal fusion, heart and kidney procedures. It is often used for laparotomies or orthopedic procedures if required. [These procedure names are mere examples. There are no blanket rules in coding, it varies from chart to chart basis.]
• When two different A-line are placed successfully then the second a-line is reported with modifier 76.
• CVP and PA Cath are not reported together. If both are marked on the record, PA cath is reported.
• CVP/PA cath are mostly encountered in brain/heart procedures. It is often encountered with other procedures too. [These procedure names are mere examples. There are no blanket rules in coding, it varies from chart to chart basis.]
• TEE are most commonly encountered (as ancillary procedures) in heart procedures. [These procedure names are mere examples. There are no blanket rules in coding, it varies from chart to chart basis.]

Type of anesthesia:

Anesthesia or analgesia is utlized to provide numbness to a certain part of the body or the entire body/nervous system, by using particular drugs, through various routes, in order to perform a surgery/diagnostic or therapeutic service.

PURPOSE:

• Main/surgical/Intra-operative/Operative anesthesia. / TOA [ ASA – 00100 – 01999]
• Analgesia / post-operative pain control. (P.O. Block)
• Patient’s operative or post-operative pain control or providing sedation at various levels.

Anesthesia is broken down into three main categories: local, regional, and general, all of which affect the nervous system in some way and can be administered using various methods and different medications. TOA / MODE OF ANESTHESIA

Here's a basic look at each kind:

1) General anesthesia. The goal is to make and keep a person completely unconscious (or "asleep") during the operation, with no awareness or memory of the surgery. General anesthesia can be given through an IV (which requires sticking a needle into a vein, usually in the arm) or by inhaling gases or vapors by breathing into a mask or tube.

    

Documentation in ASA record ;

     A) LMA (Laryngeal Mask Airway)

     B) ETT (Endotracheal Tube) 

     C) MAC BLADE no. 

     D) Airway Maintenance. GA or General Anesthesia.

      Drugs used :Propofol , Fentanyl, Midazolam, Etomidate, Ketamine, Sevoflurane, Desflurane etc. at higher dosage.

    Deepest level of anaesthesia in use.

Used in lengthy/extensive surgeries such as cardio/neuro/complex procedures.








2) Monitored anesthesia care (MAC). It is a type of anaesthesia service in which an anaesthesia staff continually monitors and supports the patient's vital functions; diagnoses and treats clinical problems that occur; administers sedative, anxiolytic, or analgesic medications if needed; and converts to general anesthesia if required. Approximately one-third of ambulatory anesthesia services for diagnostic or therapeutic procedures in the United States are provided as MAC, often in out-of-operating-room locations.

                    Drugs used: Propofol, fentanyl etc. drugs used.

Documentation in ASA record : IV / Nasal Cannula / face mask.                                              

•  No intubation takes place.
•  Pt. remains conscious/awake. Pt. remains sedated but can respond to questions/stimuli.             
•  Non-painful surgeries, low complexity surgeries or diagnostic procedures such as Colonoscopy/Endoscopy/hand or finger surgery/eye related surgeries etc. are done with MAC.
• MAC can be used alone, or sometimes in combination with regional blocks/local anesthetics etc.
• Modifier QS is required to report MAC anesthesia. G8 / G9

3)Regional anesthesia: 

• An anesthetic drug is injected near a cluster of nerves, numbing a LARGER AREA or REGION of the body (such as below the waist, like epidurals given to women in labor).
• Regional anesthesia is generally used to make a person more comfortable during and after the surgical procedure. Regional and general anesthesia are often combined.
• Pt. remains awake but cannot move that body part which gets the anesthesia.

Drugs used : Ropivacaine / Bupivacaine / Marcaine / Morphine etc.

Documentation in ASA record -Regional / Epidural / Epi / Spinal. Drug names are indications too.

Given via Injections.

Regional anesthetics is of two types:

• Peripheral Nerve Blocks: Targets peripheral nerves at periphery of body (extremities).
• Neuraxial Nerve Blocks: Targets CNS/Neuraxial nerves (spinal/epidural).