Question 1

The time reported for an anesthesia service begins __________________, and ends __________________.&#10;A)When the anesthesiologist administers the anesthetic agent; when the patient leaves the operating table.&#10;B)When the anesthesiologist begins prepping the patient; when the anesthesiologist is no longer in personal post-operative attendance.&#10;C)When the physician begins the procedure; when the physician ends the procedure.&#10;D)When the anesthesiologist begins prepping the patient; when the patient leaves the hospital.

Accepted Answer

The time reported for an anesthesia service begins when the anesthesiologist begins prepping the patient and ends when the anesthesiologist is no longer in personal post-operative attendance. According to anesthesia coding conventions, the time reported for an anesthesia service begins when the anesthesiologist begins in the pre-operative session, remains throughout the operative session, and ends in the post-operative session when the patient is no longer under the care of an anesthesiologist and can be transferred to post-operative supervision.

Question 2

PROCEDURAL NOTE PATIENT: Lopez, Olga&#10;AGE: 76 years&#10;DATE: 11/05/2014&#10;PATIENT DIAGNOSIS: Multiple skull lymphomas&#10;PROCEDURE: Craniotomy converted to craniectomy of left anterior cranial base&#10;ANESTHESIA: General endotracheal&#10;The patient was placed in supine position on operating table and anesthesia was successfully administered. The patient was then prepped in the usual manner. An incision was made on the midline of the patient's anterior cranial base and the surgeon dissected the epidermal layer to reveal the skull. Three .2 to .4cm lymphomas were then located and the skull bone was excised in one piece to remove the affected areas, leaving .1cm margins. Halfway through the procedure the patient's blood pressure dropped, which was difficult to control for the remainder of the procedure. Due to the patient's drop in blood pressure, the surgeon decided to convert the procedure to a craniectomy, therefore bone grafts were not placed. A drain was placed beneath the remaining skull base and the edges of the skin were then sutured back together using 4-0 vicryl sutures. A sterile dressing was placed on the excision site. The patient was then removed from endotracheal anesthesia and remained under physician supervision until her blood pressure stabilized. The patient was then taken to the recovery room and scheduled for a bone graft at a later date.&#10;In the above procedural scenario, the anesthesiologist spent 30 minutes prepping and administering the anesthesia to the patient. The surgeon spent 2 hours 15 minutes performing the procedure and then another hour and a half was spent after the patient was removed from anesthesia and returned to post-operative recovery. The anesthesiologist supervised the patient in post-op recovery for an additional 30 minutes.&#10;How much time should the anesthesiologist report for his service?&#10;A)4 hours 45 minutes&#10;B)2 hours 15 minutes&#10;C)4 hours 15 minutes&#10;D)3 hours 45 minutes

Accepted Answer

The anesthesiologist should report 4 hours 45 minutes as the time performed for this service. According to anesthesia coding guidelines, the time reported should begin when the anesthesiologist begins prepping the patient for anesthesia services and end when the anesthesiologist is no longer in attendance. Because the anesthesiologist was in attendance an additional 30 minutes in the post-op recovery room, the full time should be reported.

Question 3

Anesthesia that is administered intravenously, results in a complete loss of consciousness and affects the entire body is referred to as what type of anesthesia?&#10;A)Regional&#10;B)Local&#10;C)General&#10;D)Intrathecal

Accepted Answer

General anesthesia is typically administered intravenously, results in a complete loss of consciousness and affects the entire body. Regional anesthesia only affects a specific body area, and local anesthesia affects a local body area. Intrathecal anesthesia is a type of local anesthesia that is injected directly into the spinal fluid.

Question 4

Ms. McClinton was administered anesthesia by an anesthesiologist in her dentist's office when she was seen for her dental procedure. The dentist usually performs the procedure with a local anesthetic, but anesthesia was administered in this circumstance due to the patient's extreme anxiety. What would be the correct modifier for the procedure?

A)-23
B)-22
C)-47
D)-26

Accepted Answer

Modifier-23 (Unusual Anesthesia) is the correct modifier. The dental procedure would have normally been performed under local anesthesia, but due to the unusual circumstances, an anesthesiologist was required to administer a heavier dose of anesthesia to the patient. Modifier -47 is incorrect because the anesthesia was administered by the anesthesiologist not a surgeon.

Question 5

A physician harvested a viable left cornea, liver, and heart from a declared brain-dead patient. What anesthesia services should have been provided?&#10;A)01990&#10;B)No anesthesia services should have been performed on a brain-dead patient&#10;C)33930, 47133-51, 65110-51&#10;D)01990-P6

Accepted Answer

The anesthesia service that should have been reported is 01990-P6, (Physiological support for harvesting or organ(s) from brain-dead patient). Modifier -P6 also should have been reported to indicate that the patient's physical status, which in this case, is a declared brain-dead patient whose organs were being removed for donor purposes.

Question 6

A physician performed a total hip arthroplasty and an excision of a patellar bone spur. Code for the anesthesia services only.&#10;A)01400, 01214&#10;B)01380, 01400&#10;C)01214&#10;D)01215, 01400

Accepted Answer

The correct anesthesia code is 01214, (Anesthesia for arthroscopic procedures of hip joint; total hip arthroplasty only). Anesthesia guidelines state that when multiple surgical procedures are performed during a single anesthetic administration, the anesthesia code representing the most complex procedure is reported. In this case, the hip arthroplasty is the most complex procedure, which makes 01214 the only code that should be reported.

Question 7

A physician performed burn debridement on a 75-year-old male, who sustained third degree burns over 13% of his body, while burning dead brush in his back yard. Code for the anesthesia services only.&#10;A)01951, 01952, 01953&#10;B)01951, 01953 (X2), 99100&#10;C)01952, 01953, 99100&#10;D)01952, 01953 (X2)

Accepted Answer

The correct codes are 01952, (Anesthesia for second and third-degree burn excisions or debridement, with or without skin grafting, any site, between 4% and 9% of total body surface area), which accounts for the first 9% of burned area and 01953, (Anesthesia for second and third-degree burn excisions or debridement, with or without skin grafting, any site, each additional 9% total body surface area or part thereof),which accounts for the remaining 4%. The code 99100, (Anesthesia for patient of extreme age, younger than 1 year and older than 70) also needs to be reported to account for the patient's advanced age.

Question 8

A 38-year-old female patient presented to the office for an extended ophthalmoscopy with retinal drawing. The physician also performed interpretation and report of the findings. The physician performing the procedure also performed the anesthesia service for the patient, due to the fact that the anesthesiologist was not available. What are the correct codes for the procedure?

A)00148-47
B)92225-47
C)92225, 00148-47
D)92225-47, 00148

Accepted Answer

The correct code is 92225-47, (Ophthalmoscopy, extended, with retinal drawing, with interpretation and report). Modifier -47, (Anesthesia by Surgeon) must be appended to indicate that the anesthesia service was performed by the physician performing the procedure. According to modifier guidelines, modifier -47 is not to be used on the anesthesia procedure code, but rather appended to the basic service code which in this case is 92225. The anesthesia service code, 00148, should not be reported.

Question 9

A 48 year-old-man suffered internal injuries as well as multiple lower body fractures in a multiple-car accident, and presented in an extremely emergent situation. The patient's liver sustained damage and was hemorrhaging. Surgery began immediately, as the patient was not expected to survive without immediate surgery. During the surgery, the orthopedic surgeon manipulated the patient's tibia fracture and set the bone with a percutaneous fixation. Code for the anesthesia services only.

A)01462, 00794-P4
B)01462, 00792
C)00792-P5
D)00792-P5, 01462

Accepted Answer

The correct code is 00792, (Anesthesia for intra-peritoneal procedures in upper abdomen including laparoscopy; partial hepatectomy or management of liver hemorrhage) and the correct physical status modifier is -P5, which indicates that the patient is in a moribund state and not expected to live without the procedure. The tibia manipulation and percutaneous fixation should not be reported separately because it is considered a minor anesthetic procedure in comparison to the management of the liver hemorrhage.

Question 10

A 17 year-old patient presented to the orthopedist office after having fallen off his skateboard. He suffered a closed fracture to the left tibia and fibula as well as a severe sprain to the right wrist. The patient was in severe pain so an anesthesiologist administered anesthesia to him, while the physician manipulated the fractures back into place and applied the cast to the lower left leg. What are the appropriate anesthesia code(s)?

A)01820, 01490
B)01462
C)01480, 01820
D)01490

Accepted Answer

The correct code for the procedure is 01490, (Anesthesia for lower leg cast application, removal, or repair). The patient received anesthesia for the cast application, which was only administered in the lower leg. There were no other anesthesia services provided.

Question 11

PROCEDURAL NOTE PATIENT: Lopez, Olga&#10;AGE: 76 years&#10;DATE: 11/05/2014&#10;PATIENT DIAGNOSIS: Multiple skull lymphomas&#10;PROCEDURE: Craniotomy converted to craniectomy of left anterior cranial base&#10;ANESTHESIA: General endotracheal&#10;The patient was placed in supine position on operating table and anesthesia was successfully administered. The patient was then prepped in the usual manner. An incision was made on the midline of the patient's anterior cranial base and the surgeon dissected the epidermal layer to reveal the skull. Three .2 to .4cm lymphomas were then located and the skull bone was excised in one piece to remove the affected areas, leaving .1cm margins. Halfway through the procedure the patient's blood pressure dropped, which was difficult to control for the remainder of the procedure. Due to the patient's drop in blood pressure, the surgeon decided to convert the procedure to a craniectomy, therefore bone grafts were not placed. A drain was placed beneath the remaining skull base and the edges of the skin were then sutured back together using 4-0 vicryl sutures. A sterile dressing was placed on the excision site. The patient was then removed from endotracheal anesthesia and remained under physician supervision until her blood pressure stabilized. She was then taken to the recovery room and scheduled for a bone graft at a later date.&#10;A)00210, 99135&#10;B)00211, 99100&#10;C)00192, 99135, 99100&#10;D)00192, 99100

Accepted Answer

The answer of PROCEDURAL NOTE PATIENT: Lopez, Olga&#10;AGE: 76 years&#10;DATE:...

Question 12

When reporting the time involved for an anesthesia procedure when do you start and stop the clock? What is the correct answer?&#10;A)Time starts when the patient is in the pre-operative waiting area before the anesthesiologist is present and ends at the end of the surgery time.&#10;B)Time starts when the patient is in the operating room and the anesthesiologist begins to prepare the patient for the induction of the anesthesia and ends in the operating room at the end of the surgery time.&#10;C)Time starts when the patient is in the operating room and the anesthesiologist begins to prepare the patient for the induction of the anesthesia and ends when the anesthesiologist is no longer in attendance after reporting to the nurses in the PACU (post-anesthesia care unit).&#10;D)Time starts when the patient is in the operating room before the anesthesiologist is in attendance and ends in the PACU after the anesthesiologist gives report to the post-anesthesia care unit nurses.

Accepted Answer

The answer of When reporting the time involved for an...

Question 13

It is possible to have more than one qualifying circumstances for an anesthesia code. What qualifying circumstance codes should be added onto the procedure code for lower abdominal hernia repair in a child younger than one year of age who became significantly hypotensive during the procedure, causing an emergency condition?

A)00834, 99100, 99135
B)00834, 99100, 99140
C)00834, 99140, 99135
D)00834, 99140

Accepted Answer

The answer of It is possible to have more than...

Question 14

A 54-year-old man is having a coronary artery bypass grafting with pump oxygenator where the anesthesiologist is also using total body hypothermia. What is the correct code for this procedure?&#10;A)00566, 99116&#10;B)00566, 99135&#10;C)00567, 99116&#10;D)00567, 99135

Accepted Answer

The answer of A 54-year-old man is having a coronary...

Deck 4: Anesthesia