Docsity
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Docsity AI
Docsity AI
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search for your university

Find the specific documents for your university's exams

Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

Anesthesia Coding and Modifiers, Exams of Nursing

Johns Hopkins University (JHU)Nursing

Guidance on using the cpt® index to identify the appropriate anesthesia codes and modifiers for various medical procedures. It covers topics such as locating anesthesia codes for specific procedures, determining the appropriate physical status modifiers, and reporting anesthesia time and qualifying circumstances. Several case scenarios that illustrate the application of anesthesia coding principles. By studying this document, readers can gain a better understanding of the complexities involved in accurately coding and reporting anesthesia services, which is essential for ensuring proper reimbursement and compliance with healthcare regulations.

Typology: Exams

2024/2025

Available from 10/23/2024

Martin-Ray-1
Martin-Ray-1 🇺🇸

4.7

(12)

9.9K documents

1 / 26

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
1
AAPC Chapter 16 Exams with Answer.
1. Using the CPT® Index, look for anesthesia for a diagnostic
thoracoscopy. Which of the following is the correct anesthesia code?
- Correct Ans: ✔✔00528
Rationale: Look in the CPT® Index for Anesthesia/Thoracoscopy. All
of these codes are related to thoracoscopy. Code 00528 describes a
diagnostic procedure not using one-lung ventilation (OLV) utilization.
2. Using your ICD-10-CM Alphabetic Index, look for the diagnosis code
for a patient with a postoperative diagnosis of pancreatic mass.
Which of the following is the correct diagnosis code? - Correct Ans:
✔✔K86.89
RATIONALE: Look in the ICD-10-CM Alphabetic Index for
Mass/pancreas; there is no listing for Mass/pancreas. Refer to
Mass/specified organ NEC - see Disease, by site. Look for
Disease/pancreas/specified NEC K86.89. The coder should not
default to the Table of Neoplasms because the term is Mass, unless
otherwise stated. Verify code selection in the Tabular List.
3. A 74-year-old patient is scheduled for a total knee replacement due
to degenerative joint disease (DJD) of his left knee. The patient had
surgery in 2012 for gastroesophageal reflux disease (GERD). Select
the correct diagnosis code(s). - Correct Ans: ✔✔M17.12
pf3
pf4
pf5
pf8
pf9
pfa
pfd
pfe
pff
pf12
pf13
pf14
pf15
pf16
pf17
pf18
pf19
pf1a

Partial preview of the text

Download Anesthesia Coding and Modifiers and more Exams Nursing in PDF only on Docsity!

AAPC Chapter 16 Exams with Answer.

  1. Using the CPT® Index, look for anesthesia for a diagnostic thoracoscopy. Which of the following is the correct anesthesia code?
    • Correct Ans: ✔✔ 00528 Rationale: Look in the CPT® Index for Anesthesia/Thoracoscopy. All of these codes are related to thoracoscopy. Code 00528 describes a diagnostic procedure not using one-lung ventilation (OLV) utilization.
  2. Using your ICD- 10 - CM Alphabetic Index, look for the diagnosis code for a patient with a postoperative diagnosis of pancreatic mass. Which of the following is the correct diagnosis code? - Correct Ans: ✔✔K86. RATIONALE: Look in the ICD- 10 - CM Alphabetic Index for Mass/pancreas; there is no listing for Mass/pancreas. Refer to Mass/specified organ NEC - see Disease, by site. Look for Disease/pancreas/specified NEC K86.89. The coder should not default to the Table of Neoplasms because the term is Mass, unless otherwise stated. Verify code selection in the Tabular List.
  3. A 74-year-old patient is scheduled for a total knee replacement due to degenerative joint disease (DJD) of his left knee. The patient had surgery in 2012 for gastroesophageal reflux disease (GERD). Select the correct diagnosis code(s). - Correct Ans: ✔✔M17.

Rationale: The patient's previous surgery has no relevance to the anesthesia for the knee surgery. DJD is an abbreviation for degenerative joint disease. Look in the ICD- 10 - CM Alphabetic Index for Degeneration, degenerative/joint disease which directs you to see Osteoarthritis. Look in the Alphabetic Index for Osteoarthritis/knee M17.1. According to Coding Clinic, Volume 3, Number 4, Fourth Quarter 2016, "When the type of osteoarthritis is not specified, 'primary' is the default." Look at M17.1 in the Tabular List and you will see Primary osteoarthritis of knee NOS. In the Tabular List, a 5th character is needed to report the laterality. Complete code is M17.12 for the left knee.

  1. 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.
  2. 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
  1. 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.
  2. A 78-year-old patient is undergoing lens surgery for cataracts. An anesthesiologist personally performed monitored anesthesia care (MAC). Which modifier(s) appropriately report(s) the anesthesiologist's service? - Correct Ans: ✔✔ 00142 - AA-QS RATIONALE: An anesthesiologist who is personally performing administration of anesthesia reports the service with an AA modifier. Because the service was performed using MAC, a QS modifier is also reported. CASE 1
  3. 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.)

  1. What CPT® and ICD- 10 - CM codes are reported for the anesthesiologist? CPT® code(s): [a] ICD- 10 - CM code(s): [b] What is the time reported for this service? - Correct Ans: ✔✔ 00865 - AA-P2, C61, 176
  2. CASE 2 ANES Start: 14:07 ANES End: 17:33 (Total anesthesia time 3 hours 26 minutes, or 206 minutes.) Physical Status: 3 Anesthesiologist: Michael D, MD (Physical status 3, use modifier P3. Personally performed by the anesthesiologist, use modifier AA.) 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

Anesthesia Start: 10:03 - Anesthesia Stop: 11:06 (Anesthesia time is 1 hour and 3 minutes, or 63 minutes.) PREOPERATIVE DIAGNOSIS: Sternal wound hematoma. POSTOPERATIVE DIAGNOSIS: Complicated upper abdominal wall wound.(Postoperative diagnosis used for coding if no other indication is found in the operative note.) NAME OF PROCEDURE: Sternal wound exploration and wound vac placement.(Procedure performed.) ANESTHESIA: Monitored Anesthesia Care(Use modifier QS to indicate MAC is used.)

  1. 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 - Correct Ans: ✔✔ 00700 - AA-QS-P2, L76.32, 63 CASE 5 ANES Start: 12: ANES End: 13: (Reported anesthesia time in minutes.) CRNA: John Sleep, CRNA (Non-Medically Directed) (Modifier QZ used to indicate services are performed by a CRNA with no medical direction.) ASA Physical Status: 3 (Physical status 3—use modifier P3.) Operative Report Preoperative diagnosis: Stricture of the left ureter, postoperative Postoperative diagnosis: SAME (Postoperative diagnosis is the same as preoperative which is stricture of the left ureter, postoperative.) Procedure:

Cystoscopy of ileal conduit. Exchange of left nephroureteral catheter. Anesthesia: Monitored anesthesia care. (Modifier QS is used to indicate MAC.)

  1. Description of Procedure: The patient is identified in the holding area, marked, taken to the operating room. Subsequently, she was given monitored anesthesia care. She was prepped and draped in the usual sterile fashion in the supine position. Next, using a fle - Correct Ans: ✔✔ 00860 - QZ-QS-P3, N13.5, 73
  2. CASE 6 CRNA performed anesthesia Anesthesiologist medically directing two cases Anesthesia Time: 9:30 to 10: Physical Status: 3 PREOPERATIVE DIAGNOSIS: Cyst behind knee POSTOPERATIVE DIAGNOSIS: Baker's cyst PROCEDURE: Excision of Baker's cyst, knee ANESTHESIA: Monitored Anesthesia Care
  3. What CPT® and ICD- 10 - CM codes are reported for the anesthesiologist? CPT® code: [a] ICD- 10 - CM code: [b] What CPT® and ICD- 10 - CM codes are reported for the CRNA? CPT® code: [c] ICD- 10 - CM code: [d]
  1. CRNA performed anesthesia under medical direction of anesthesiologist
  2. Anesthesiologist medically directing three cases
  3. Anesthesia Time: 8:52 to 9:
  4. Physical Status: 1
  5. PREOPERATIVE DIAGNOSIS: Phimosis, congenital
  6. POSTOPERATIVE DIAGNOSIS: Phimosis, congenital
  7. PROCEDURE: Circumcision on six-month-old boy
  8. ANESTHESIA: Monitored Anesthesia Care
  9. What CPT® and ICD- 10 - CM codes are reported for the anesthesiologist?
  10. What CPT® and ICD- 10 - CM codes are reported for the CRNA?
  11. What is the time reported for this service? - Correct Ans: ✔✔ 00920 - QK-QS-P1, 99100, N47.1, 00920-QX-QS-P1, N47.1, 42
  12. CASE 9
  13. Non-medically directed CRNA performed anesthesia care and documented intra-operative placement of continuous femoral nerve catheter for post operative pain.
  14. Anesthesia Time: 7:18 to 9:
  15. Physical Status: 3
  16. PREOPERATIVE DIAGNOSIS: Left knee osteoarthritis
  17. POSTOPERATIVE DIAGNOSIS: Left knee osteoarthritis, localized primary , Acute postoperative pain
  18. PROCEDURE: Total Knee Arthroplasty
  19. ANESTHESIA: General anesthesia provided for surgery. Surgeon requested postoperative pain management via continuous femoral catheter
  1. What CPT® and ICD- 10 - CM codes are reported for the CRNA?
  2. What is the time reported for this service? - Correct Ans: ✔✔ 01402 - QZ-P3, 64448- 59 - LT, M17.12, G89.18, 112
  3. CASE 10
  4. CRNA directly supervised by anesthesiologist who is directing two other cases.
  5. CRNA inserted a separate CVL, Swan-Ganz catheter, and an A-line
  6. Patient has a severe systemic disease that is a constant threat to life
  7. Anesthesia Time: 11:43 to 15:
  8. PREOPERATIVE DIAGNOSIS: Multivessel coronary artery disease.
  9. POSTOPERATIVE DIAGNOSIS: Coronary artery disease, native artery
  10. NAME OF PROCEDURE: Coronary artery bypass graft x 3, left internal mammary artery to the LAD, saphenous vein graft to the obtuse marginal, saphenous vein graft to the diagonal.
  11. ANESTHESIA: General
  12. BRIEF HISTORY: This 77-year-old patient who was found to have a huge aneurysm. Preoperative cardiac clearance revealed a markedly positive stress test and cardiac catheterization showed critical left- sided disease. Coronary revascularization was recommended. The patient has multiple medical illnesses including chronic obstructive pulmonary disease wit - Correct Ans: ✔✔ 00567 - QK-P4, 99100, I25.10, 00567-QX-P4, 36556-59, 93503, 36620-51, I25.10, 223
  13. CPT® Codes: The procedure performed was a CABG (Coronary Artery Bypass Graft). To locate the service in the CPT® Index, look for

requiring anesthesia. What modifier is appended to the service? - Correct Ans: ✔✔ 23

  1. 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.
  2. What are the three classifications of anesthesia? - Correct Ans: ✔✔General, regional, and monitored anesthesia Care
  3. 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.
  4. What is the anesthesia code for a shoulder arthroscopy which became an open procedure on the shoulder joint? - Correct Ans: ✔✔ 01630
  5. 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.
  1. What is the anesthesia code for a cast application to the wrist? - Correct Ans: ✔✔ 01860
  2. Rationale: Look in the CPT® Index for Anesthesia/Cast Application/Forearm, Wrist and Hand which directs you to 01860. Verify code selection in the numeric section.
  3. What physical status modifier best describes a patient who has a severe systemic disease that is a constant threat to life? - Correct Ans: ✔✔P
  4. Rationale: Review the Anesthesia Guidelines in the CPT® code book to determine that the physical status modifier P4 is the correct choice. Note: Medicare does not recognize physical status modifiers for additional payment.
  5. 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 coding is reported? - Correct Ans: ✔✔T80.211A
  6. 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

Alphabetic Index for Disease/uterus/specified NEC, which directs you to code N85.8. Confirm code in the Tabular list. Do not select code D39.8, uncertain behavior, from the Table of Neoplasms because to report this code you need to see a pathology report to support the findings of a neoplasm of uncertain behavior.

  1. A 42-year-old patient was admitted to an ASC and began having complications in the OR after the induction of anesthesia. The surgeon immediately discontinued the planned surgery. If the insurance company requires a reported modifier, what modifier best describes the extenuating circumstances for the anesthesiologist? - Correct Ans: ✔✔ 53
  2. Rationale: In the CPT® code book go to Appendix A and look for modifiers. Review the modifiers to determine that modifier 53 best describes the anesthesia service, which was discontinued prior to the start of surgery. Modifier 73 is only reported by the facility for the use of the facility. Modifier 73 is never reported for physician anesthesia services. The anesthesiologist will report the intended anesthesia code with the start and stop anesthesia time.
  3. After a routine and uncomplicated appendix surgery, the patient began bleeding postoperatively. What ICD- 10 - CM coding is reported? - Correct Ans: ✔✔K91.
  4. Rationale: In the ICD- 10 - CM Alphabetic Index look for Complication/hemorrhage/postprocedural directing you to see

Complication, postprocedural, hemorrhage. In the Alphabetic Index 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.

  1. Following labor and delivery, the mother developed acute kidney failure. What ICD- 10 - CM coding is reported? - Correct Ans: ✔✔O90.
  2. Rationale: In the ICD- 10 - CM Alphabetic Index look for Failure/renal/following labor and delivery (acute), which directs you to code O90.4. Verify code selection in the Tabular List. Note: When the failure occurred the patient had already given birth so it should not be coded as a complication during pregnancy.
  3. A patient has foot surgery for a right calcaneal spur. Chronic myocardial ischemia was listed on the pre-anesthesia assessment. What ICD- 10 - CM coding is reported? - Correct Ans: ✔✔M77.31, I25.
  4. Rationale: In the ICD- 10 - CM Alphabetic Index look for Spur, bone/calcaneal, which directs you to M77.3-. Next, in the Alphabetic Index look for Ischemia, ischemic/heart (chronic or with a stated duration of over four weeks), which directs you to I25.9. In the Tabular List confirm the code selection. Code M77.3- indicates that a 5th character is needed to define the laterality of the foot. For a
  1. Rationale: In ICD- 10 - CM Alphabetic Index look for Glaucoma/traumatic/newborn (birth injury), which directs you to code P15.3. ICD- 10 - CM guideline I.C.16.a.1 indicates that chapter 16 codes may be used throughout the life of the patient if the condition is still present. Note: Congenital is defined as present at birth, such as a birth defect. This injury was caused or acquired during the birth.
  2. A 94-year-old patient (Medicare beneficiary) is having surgery to remove his parotid gland with dissection and preservation of the facial nerve. The surgeon has requested the anesthesia department place an arterial line. What CPT® coding is reported for anesthesia? - Correct Ans: ✔✔00100, 36620, 99100
  3. Rationale: In the CPT® Index look for Anesthesia/Salivary Glands which directs you to code 00100. Reference the code in the numeric section to confirm that 00100 is the correct code. Hint - Coders may need to use the Surgery Section to determine that the parotid gland is included in the salivary glands. The arterial line placement is NOT included in the base value and may be reported separately with code
    1. In the CPT® Index look for Catheterization/Arterial System/Percutaneous. Due to patient's advanced age of 94, qualifying circumstance add-on code +99100 is also reported. Furthermore, because the patient is a Medicare beneficiary, we do not use Physical Status Modifiers as they are not accepted by Medicare.
  4. A preanesthesia assessment was performed and signed at 10: am. Anesthesia start time is reported as 12:26 pm, and the surgery

began at 12:37 pm. The surgery finished at 15:12 pm and the patient was turned over to PACU at 15:26 pm, which was reported as the ending anesthesia time. What is the anesthesia time reported? - Correct Ans: ✔✔12:26 pm to 15:26 pm (180 minutes)

  1. Rationale Per Anesthesia Guidelines in the CPT® codebook under the subheading Time Reporting: Anesthesia time begins when the anesthesiologist begins to prepare the patient for anesthesia in either the operating room (or an equivalent area) and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision. Anesthesia start time (12:26) and the anesthesia end time (15:26) calculates as 3 hours or 180 minutes of total anesthesia time.
  2. An 11-month-old patient presented for emergency surgery to repair a severely broken arm after falling from a third story window. What qualifying circumstance code(s) may be reported in addition to the anesthesia code? - Correct Ans: ✔✔99100, 99140
  3. Rationale: In the CPT® Anesthesia Guidelines under Qualifying Circumstances each of the qualifying circumstances codes identifies a different circumstance, and more than one may be appended when applicable, unless the reported anesthesia code already contains the risk factor. In this case, 99100 is assigned for extreme age of one year or younger and 99140 is assigned for emergency conditions. Note: Qualifying circumstances codes may also be found in the CPT® Medicine subheading Miscellaneous Services/Qualifying Circumstances for Anesthesia.