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AAPC Chapter 16: Anesthesia Exam
2024/2025 with Correct Answers.
A 67-year-old patient is undergoing anesthesia for a re-operation after a coronary bypass two months ago. Which of the following qualifying circumstances may be reported separately? - Correct Ans: ✔✔None of the above RATIONALE: Qualifying circumstances may not be separately reported if the anesthesia code already takes difficulty into consideration. An anesthesiologist was called to the emergency room to intubate a patient with respiratory difficulty. Which procedure code is reported? - Correct Ans: ✔✔ 31500 RATIONALE: The anesthesiologist is not providing an intubation for a patient undergoing anesthesia. An emergency intubation is correctly reported as 31500. Look in the CPT® Index for Intubation/Endotracheal Tube. Which of the following physical status modifiers best describes a normal health patient who is undergoing anesthesia? - Correct Ans: ✔✔P RATIONALE: A normal healthy patient is reported with physical status modifier P1. No additional value is recognized.
A CRNA is personally performing a case, without medical direction from an anesthesiologist. Which modifier reports the CRNA services? - Correct Ans: ✔✔QZ RATIONALE: A CRNA without medical direction is reported with QZ modifier. An anesthesiologist is medically supervising five cases at the same time. Which modifier(s) report(s) the anesthesiologist and CRNA services? - Correct Ans: ✔✔AD and QX RATIONALE: An anesthesiologist who is medically supervising reports the service separately from the CRNA. Supervision of more than four concurrent anesthesia procedures is reported with modifier AD. The CRNA reports with modifier QX. A 69-year-old Medicare patient with a history of severe cardiopulmonary disease is undergoing surgery with monitored anesthesia care (MAC). Which modifier(s) is used for monitored anesthesia care service? - Correct Ans: ✔✔G RATIONALE: Anesthesia care for a Medicare patient who is undergoing MAC and has a history of severe cardiopulmonary disease is reported with modifier G9. The additional modifier QS is not necessary because the description for G9 includes monitored anesthesia care. CASE 1
What are the CPT® and ICD- 10 - CM Codes reported for the Anesthesiologist? What are the CPT® and ICD- 10 - CM Codes reported for the CRNA? What is the time reported for this service? - Correct Ans: ✔✔ 01400 - QK-QS-P3, M71.20; 01400 - QX-QS-P3, M71. 36 CASE 2 Anesthesiologist personally performed (Personally performed by anesthesiologist—use AA modifier.) Anesthesia Time: 7:12 to 10:08 (Time is 176 minutes.) Physical Status 2 (Physical status 2, use P2 modifier.) PREOPERATIVE DIAGNOSIS: Suspected Prostate Cancer POSTOPERATIVE DIAGNOSIS: Prostate Carcinoma (Post-operative diagnosis.)
PROCEDURE: Radical Retropubic Prostatectomy (Procedure performed. Make note the procedure is "radical.") ANESTHESIA: General (General anesthesia.) What are the CPT® and ICD- 10 - CM Codes reported for the Anesthesiologist? What is the time reported for this service? - Correct Ans: ✔✔ 00865 - AA-P2; C61; 176 CASE 3 Non-medically directed CRNA (CRNA services without medical direction require modifier QZ.) performed anesthesia care and documented intra-operative placement of continuous femoral nerve catheter for post operative pain. (Anesthesia and intraoperative placement of continuous femoral nerve catheter.) Anesthesia Time: 7:18 to 9:10 (Time calculates to 1 hour 52 minutes, or 112 minutes.)
Operative report Preoperative diagnosis: Lumbar spinal stenosis Postoperative diagnosis: L4-L5 spinal stenosis (Post-operative diagnosis of lumbar (L4-L5) stenosis.) Procedure: L4-5 laminectomy, removal of synovial cyst, bilateral medial facetectomy and posterolateral fusion L4-L5 with vertebral autograft, bone morphogenic protein, chip allograft, all with intraoperative somatosensory evoked potentials, electromyographies and loupe magnification. (The following procedures were performed: L4- 5 laminectomy, removal of synovial cyst, bilateral medial facetectomy and posterolateral fusion L4-L5 with vertebral autograft, bone morphogenic protein, chip allograft, all - Correct Ans: ✔✔ 00630 - AA-P M48. 206 CASE 5 CRNA directly supervised by anesthesiologist (CRNA directly supervised by the Anesthesiologist supports modifier QX.) who is directing two
other cases. (Anesthesiologist was directing two cases, this supports the use of modifier QK.) CRNA inserted a separate CVP Swan-Ganz catheter ,(Swan-Ganz is reported separately by the CRNA.) (CVP is reported separately by the CRNA.) and an A-line (A-line (Arterial line) is reported separately by the CRNA.) Patient has a severe systemic disease that is a constant threat to life (Supports modifier P4 for physical status 4.) Anesthesia Time: 11:43 to 15:26 (Time calculates to 3 hours 43 minutes or 223 minutes.) PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease. POSTOPERATIVE DIAGNOSIS: Coronary artery disease, native artery (Post-operative diagnosis should be used for diagnosis reporting.) NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal ma - Correct Ans: ✔✔ 00567 - QK-P4, 99100 I25. 00567 - QX-P4, 36556-59, 93503, 36620 I25.
What are the CPT® and ICD- 10 - CM Codes reported for the CRNA? What is the time reported for this service? - Correct Ans: ✔✔ 00920 - QK-QS-P1, 99100; N47. 00920 - QX-QS-P1; N47. 42 CASE 7 CRNA performed anesthesia under medical direction of anesthesiologist Anesthesiologist medically directing one case CRNA placed arterial line Anesthesia Time: 10:43 to 12: Physical Status 3 PREOPERATIVE DIAGNOSIS: Left Renal Mass
POSTOPERATIVE DIAGNOSIS: Same PROCEDURE: Left Partial Nephrectomy, Laparoscopic ANESTHESIA: General PROCEDURE DESCRIPTION: Abdominal wall insufflated. The laparoscope was placed through the umbilical port and additional trocars were placed into the abdominal cavity. Using the fiberoptic camera, the renal mass was identified and the diseased kidney tissue was removed using electrocautery. Minimal bleeding is noted. Instruments were removed and the abdominal incisions were closed by suture. Patient tolerated surgery well and was transferred to the Post Anesthesia Care Unit in satisfactory condition. What are the CPT® and ICD- 10 - CM Codes reported for the Anesthesiologist? W - Correct Ans: ✔✔ 00862 - QY-P3; N28. 00862 - QX-P3, 36620; N28. 127 CASE 8
What are the CPT® and ICD- 10 - CM Codes reported for the Anesthesiologist? What is the time reported for this service? - Correct Ans: ✔✔ 00520 - AA-QS-P C34. 37 CASE 9 Anesthesia services personally provided by Anesthesiologist Physical Status 2 Anesthesia Start: 10:03 - Anesthesia Stop: 11: PREOPERATIVE DIAGNOSIS: Sternal wound hematoma. POSTOPERATIVE DIAGNOSIS: Complicated upper abdominal wall wound. NAME OF PROCEDURE: Sternal wound exploration and wound vac placement.
ANESTHESIA: Monitored Anesthesia Care BRIEF HISTORY: He is a 52-year-old patient who is two weeks out from re-do sternotomy and aortic valve replacement for critical aortic stenosis in the setting of heart failure. He had a postoperative coagulopathy and required sternal re-exploration with open packing. He was closed the next day. He had serous discharge prior to going home but this was culture negative and the wound looked very good. He continued to have serous discharge in the clinic and it was felt he had a retained hematoma. He was scheduled for evaluation of the hematoma and wound vac placem - Correct Ans: ✔✔ 00700 - AA-QS-P L76. 63 CASE 10 ANES Start: 12: ANES End: 13: CRNA: John Sleep, CRNA (Non-Medically Directed)
the ileal conduit was entered. Cystoscopy was performed, which showed the ureteroileal anastomosis on the left with a stent protruding from it. There were no calcifications seen on the stent. Thus, the cystoscope was removed from the ileal conduit and then a super stiff - Correct Ans: ✔✔ 00860 - QZ-QS-P N13. 73 What is the anesthesia code for a shoulder arthroscopy which became an open procedure on the shoulder joint? - Correct Ans: ✔✔ 01630 Rationale: In the CPT® Index, look for Anesthesia/Arthroscopic Procedures/Shoulder which directs you to code range 01622-01638. Review the codes in the numeric section to determine 01630 is the appropriate code selection because the description of the code includes open or surgical arthroscopic procedures. Report the appropriate anesthesia code for an obstetric patient who had a planned general anesthesia for cesarean hysterectomy. - Correct Ans: ✔✔ 01963 Rationale: Use the CPT® Index look for Anesthesia/Hysterectomy/Cesarean which directs you to 01963, 01969. Review the codes in the numeric section to determine that code 01963 is the appropriate code. Note: Code 01969 is an add-on code and cannot be coded without a primary procedure code.
A 22 year-old patient who has severe medical problems is placed under general anesthesia by an anesthetist for a service not usually requiring anesthesia. What modifier would be appended to the service? - Correct Ans: ✔✔ 23 Rationale: In the CPT® codebook go to Appendix A - Modifiers. Review the modifiers to determine that modifier 23 is reported to indicate a procedure not usually requiring anesthesia (either none or local) but due to unusual circumstances general anesthesia is necessary. What are the three classifications of anesthesia? - Correct Ans: ✔✔General, Regional and Monitored Anesthesia Care Rationale: An epidural is a type of regional anesthesia. Moderate or conscious sedation is typically provided by the same physician performing the service sedation supports and requires the presence of an independent observer to monitor the patient. What is the anesthesia code for a mediastinoscopy utilizing OLV (one lung ventilation)? - Correct Ans: ✔✔ 00529 Rationale: In the CPT® Index look for Anesthesia/Mediastinoscopy directing you to codes 00528, 00529. These codes represent mediastinoscopy and diagnostic thoracoscopy. Review the codes in the numeric section to determine that 00529 describes the procedure utilizing one lung ventilation (OLV). Following labor and delivery, the mother developed acute kidney failure. What ICD- 10 - CM code is reported? - Correct Ans: ✔✔O90.
Neoplasms because to report this code we need to see a pathology report to support the findings of a neoplasm of uncertain behavior. What is the anesthesia code for a complete removal of the penis, including removal of both the left and right inguinal and iliac lymph nodes? - Correct Ans: ✔✔ 00936 Rationale: In the CPT® Index look for Anesthesia/Penis which directs you to code range 00932-00938. Review the codes in the numeric section to determine 00936 fully describe the procedure and it is the correct code. A patient undergoes heart surgery for angina decubitus and coronary artery disease (CAD). What ICD- 10 - CM code is reported? - Correct Ans: ✔✔I25. Rationale: In the ICD- 10 - CM Alphabetic Index look for Disease/coronary (artery) which states see Disease/heart/ischemic/atherosclerotic (of) with angina pectoris which directs you to see Arteriosclerosis, coronary (artery). Look for Arteriosclerosis/coronary (artery)/native vessel/with/angina/specified type NEC which directs you to I25.118. Verify code selection in the Tabular List. After a routine and uncomplicated appendix surgery, the patient began bleeding post-operatively. What ICD- 10 - CM code is reported? - Correct Ans: ✔✔K91. Rationale: In the ICD- 10 - CM Alphabetic Index look for Complication/hemorrhage/postprocedural directs you to see
Complication, postprocedural hemorrhage. Look for Complication/postprocedural /hemorrhage (hematoma) (of)/digestive system/following procedure on digestive system which directs you to code K91.840. Verify code selection in the Tabular List. What is the appropriate code for a patient who had regional block anesthesia provided for carpal tunnel surgery? - Correct Ans: ✔✔ 01810 Rationale: In this example it is important to understand the type of anesthesia provided will not determine the anesthesia code. In the CPT® Index look for Anesthesia/Arm/Lower which directs you to code ranges 00400, 01810-01820, 01830-01860. Review the codes in the numeric section to determine code 01810 is correct. The coder must know that carpal tunnel surgery refers to the median nerve in the wrist. Hint - Try looking up the surgical code for clues to the anatomical area when necessary for assistance. The patient had surgery to remove and replace an existing Hickman catheter. The anesthesiologist reported a postoperative diagnosis of a catheter related bloodstream infection (CRBSI). What ICD- 10 - CM code(s) is/are reported? - Correct Ans: ✔✔T80.211A Rationale: A catheter related bloodstream infection (CRBSI) is a complication. In ICD- 10 - CM Alphabetic Index look for Infection/due to or resulting from/Hickman catheter/bloodstream which directs you to code T80.211-. In the Tabular List a 7th character is required to complete the code. Character A is selected for initial encounter.
