# New to anesthesia coding - have many questions!



## sfaltinson (Jun 21, 2010)

Hi, all

I'm brand new to anesthesia coding and need some answers quick! For starters, my questions include the following: 

For MAC:

1)  Can time be rounded? Example: Total sedation time is 64 min. Are the time units 4 or 5? 

2)  When exactly are the start and stop times? In the MHCP (Minnesota Hlth Care Programs) anesthesia services policy, start time is listed as "preparation of the recipient for induction" and stop is when the provider is "no longer in personal attendance". What is included in "induction"? Is that where the RN starts the IV line? 

3)  What is Phase I and Phase II recovery? Is this included in the MD time?

For conscious/moderate sedation:

1)  Can time be rounded? Example: Total time for 5+ year old pt = 50 min. Are the correct codes 99143 x 1 and 99145 x 1, accounting for 45 min. Are the extra 5 minutes captured with another unit of 99145?

2)  When are the start/stop times?

Diagnoses:

1)  I gather that the primary diagnosis is the reason for the procedure itself (example: AML for LP w/chemo). My docs are including pain (780.96) and anxiety (300.00) as additional dx. Some even list these as primary dx. Thoughts on this?

Thanks in advance to those who answer. Please include your sources along with your answers.

Sara
Minneapolis, MN


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## dwaldman (Jun 22, 2010)

I don't know the answers to all your questions. The system we enter are charges has a start time and end time. We look at the anesthesia record and the anesthesiologist or CRNA indicate what the start and end time are. We placed those in the system and it gives us the minutes. We bill the appropriate anesthesia code and then place the minutes in the units field and determine correct modifiers according what other cases were done that day. Have you purchased a Relative Value Guide they have some good information. Also you can look at the Medicare claims processing manual in regards to their medical policy on Anesthesia services. And then attempt to acquire other policies from the commercial carriers to see if this differentiate from Medicare polices. I know this doesn't answer even half of your question but I just wanted to mention the Relative Value Guide since I see others reference from that.


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## sfaltinson (Jun 23, 2010)

Thanks - I appreciate your reply. 

Sara


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