AAPC Chapter 16: Anesthesia with expert interventions (Guaranteed Success)
Using the CPT® Index, look for anesthesia for a modified radical mastectomy with internal
mammary node dissection. Which of the following is the correct anesthesia code? - answer
00406
RATIONALE: Anesthesia/Mastectomy is not listed in the CPT® Index. Look for Anesthesia/Breast
to see the code range. Code 00406 is the appropriate anesthesia code for a radical mastectomy
with internal mammary node dissection.
Using the CPT® Index, look for anesthesia for a diagnostic thoracoscopy. Which of the following
is the correct anesthesia code? - answer 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 1 lung ventilation
utilization.
Using your ICD-10-CM Alphabetic Index, look for the diagnosis code for a patient with a
preoperative diagnosis of abdominal pain, right lower quadrant and a postoperative diagnosis of
uterine fibroids. Which of the following is the correct diagnosis code? - answer D25.9
RATIONALE: The preoperative diagnosis is disregarded because a more definitive diagnosis is
determined following surgery. Look in the ICD-10-CM Alphabetic Index for Fibroid/uterus D25.9.
Verify code selection in the Tabular List.
A patient is scheduled for monitored anesthesia care (MAC) to remove an eyelid cyst. Normally
the surgeon provides moderate sedation for the removal; however, this patient has a history of
failed moderate sedation. Select the correct diagnosis code(s). - answer H02.829, Z92.83
RATIONALE: The reason for the anesthesiologist's involvement for the monitored anesthesia
care (MAC) in the surgery is the patient's history of failed moderate sedation. The eye cyst is
first-listed as it is the medical necessity for the surgery and Z92.83 is an additional diagnosis to
explain the need for anesthesia care. In the ICD-10-CM Alphabetic Index, look for Cyst/eyelid
(sebaceous) directing you to H02.829. Next, look in the Alphabetic Index for History/personal
(of)/failed conscious sedation directing you to Z92.83. Verify code selection in the Tabular List.
,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? -
answer 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? - answer 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? - answer P1
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? - answer 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? - answer 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? - answer G9
, 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
CRNA performed anesthesia (Use Modifier QX to indicate CRNA services with medical direction
by a physician.)
Anesthesiologist medically directing two cases (Use modifier QK to indicate medical direction of
two cases.)
Anesthesia Time: 9:30 to 10:06
Physical Status 3 (Physical status 3 - use P3 modifier.)
PREOPERATIVE DIAGNOSIS: Cyst on knee
POSTOPERATIVE DIAGNOSIS: Baker's Cyst (Use post-operative diagnosis.)
PROCEDURE: Excision of Baker's Cyst, knee (Excision is an open procedure and is performed on
the knee.)
ANESTHESIA: Monitored Anesthesia Care (MAC services require QS modifier.)
What are the CPT® and ICD-10-CM Codes reported for the Anesthesiologist?
Using the CPT® Index, look for anesthesia for a modified radical mastectomy with internal
mammary node dissection. Which of the following is the correct anesthesia code? - answer
00406
RATIONALE: Anesthesia/Mastectomy is not listed in the CPT® Index. Look for Anesthesia/Breast
to see the code range. Code 00406 is the appropriate anesthesia code for a radical mastectomy
with internal mammary node dissection.
Using the CPT® Index, look for anesthesia for a diagnostic thoracoscopy. Which of the following
is the correct anesthesia code? - answer 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 1 lung ventilation
utilization.
Using your ICD-10-CM Alphabetic Index, look for the diagnosis code for a patient with a
preoperative diagnosis of abdominal pain, right lower quadrant and a postoperative diagnosis of
uterine fibroids. Which of the following is the correct diagnosis code? - answer D25.9
RATIONALE: The preoperative diagnosis is disregarded because a more definitive diagnosis is
determined following surgery. Look in the ICD-10-CM Alphabetic Index for Fibroid/uterus D25.9.
Verify code selection in the Tabular List.
A patient is scheduled for monitored anesthesia care (MAC) to remove an eyelid cyst. Normally
the surgeon provides moderate sedation for the removal; however, this patient has a history of
failed moderate sedation. Select the correct diagnosis code(s). - answer H02.829, Z92.83
RATIONALE: The reason for the anesthesiologist's involvement for the monitored anesthesia
care (MAC) in the surgery is the patient's history of failed moderate sedation. The eye cyst is
first-listed as it is the medical necessity for the surgery and Z92.83 is an additional diagnosis to
explain the need for anesthesia care. In the ICD-10-CM Alphabetic Index, look for Cyst/eyelid
(sebaceous) directing you to H02.829. Next, look in the Alphabetic Index for History/personal
(of)/failed conscious sedation directing you to Z92.83. Verify code selection in the Tabular List.
,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? -
answer 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? - answer 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? - answer P1
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? - answer 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? - answer 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? - answer G9
, 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
CRNA performed anesthesia (Use Modifier QX to indicate CRNA services with medical direction
by a physician.)
Anesthesiologist medically directing two cases (Use modifier QK to indicate medical direction of
two cases.)
Anesthesia Time: 9:30 to 10:06
Physical Status 3 (Physical status 3 - use P3 modifier.)
PREOPERATIVE DIAGNOSIS: Cyst on knee
POSTOPERATIVE DIAGNOSIS: Baker's Cyst (Use post-operative diagnosis.)
PROCEDURE: Excision of Baker's Cyst, knee (Excision is an open procedure and is performed on
the knee.)
ANESTHESIA: Monitored Anesthesia Care (MAC services require QS modifier.)
What are the CPT® and ICD-10-CM Codes reported for the Anesthesiologist?
