Anesthesia Coding Alert

Educate providers so they use the same classification guidelines.

Many aspects of anesthesia coding are unique to the specialty, such as the use of physical status (or “P”) modifiers. These six modifiers are added to claims to help the anesthesia provider paint a clearer picture of the patient’s health for the insurer.

Why it’s important: A patient’s health status can make a difference in the types of treatments she receives or how those treatments are offered. Health status can also impact an anesthesia provider’s reimbursement because patients with certain conditions can be a higher risk for anesthesia.

We asked two long-time coders to share their insights on successfully reporting P modifiers. Read on to learn what real-world advice they offered.

Stress the Importance of Documentation

The differences between P modifiers seem simple at first glance, but can quickly shift from “black and white” to “gray” if you don’t have clear documentation from your provider.

“P2 probably is reported most often since many patients have some form of mild systemic medical problem such as high blood pressure or hypothyroidism,” says Catherine Brink, BS, CMM, CPC, CPOM, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. “Medical record documentation of diagnosis(es) to support P2, P3, or P4 is key.”

Understand What the Documentation Means

Your anesthesia provider most likely assigns the patient’s P status. As a coder, it’s important for you to understand what the documented diagnoses mean and whether they support the criteria of mild, severe, or life-threatening – and the P modifier assignment.

Consider these examples from the American Society of Anesthesiologists of how you should interpret each term:

• Mild – The disease does not have substantive functional limitations (such as current smoker, social alcoholic drinker, well-controlled diabetes or hypertension, obesity with BMI less than 40, or mild lung disease)
• Severe – One or more moderate to severe diseases that lead to substantive functional limitations (including poorly controlled diabetes or hypertension, COPD, morbid obesity, implanted pacemaker or alcohol dependence or abuse)
• Life-threatening or constant threat to life – Having conditions such as a recent MI, TIA, or CAD/stents, ongoing cardiac ischemia, sepsis, ruptured abdominal or thoracic aneurysm, or massive trauma.

Get Your Providers in Sync

“One challenge we have with assigning physical status classification is variation in how it’s applied by our physicians,” says Tacy Brown, a coder with Mountain West Anesthesia in Lehi, Utah. “There seem to be some questions regarding the intent of physical status classification. Some anesthesiologists look at the total situation as anesthesia is induced and others just at the patient’s physical condition prior to an injury or surgery. Are the P modifiers used to determine risk assessment, or just the patient’s physical condition? And does the nature of the surgery possibly change the physical status assignment? If the physical status can be changed by injury and not only by disease, then that also can change the possible classification.”

For example, a young, healthy patient comes into the Emergency Department with an open fracture and significant blood loss. One physician might classify him a P1 because he was healthy before the accident. Another might assign P4 because of the current threat to life due to the injury and blood loss.

“The physical status system is used to describe the patient’s ‘risk’ for surgery,” explains Kelly D. Dennis, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “So a healthy patient should be classified according to his or her current risk. If coders see variances in how their anesthesia providers are classifying patients, they can use this as an ‘educational moment’ to ensure every provider follows the ASA criteria that is now available.”

Another explanation: According to the Cleveland Clinic, “The purpose of the grading system is simply to evaluate the degree of a patient’s ‘sickness’ or ‘physical state’ before selecting the anesthetic or before performing surgery. Describing patients’ preoperative physical status is used for recordkeeping, for communicating between colleagues, and to create a uniform system for statistical analysis.” 

Keep Communicating to Stay Consistent

Brink and Brown agree that communication is the most important factor in correctly reporting these modifiers.

“Coders need to help providers understand the importance of medical record documentation and diagnosis reporting,” Brink says. “There also needs to be ongoing communication between coders and anesthesiologists to keep providers informed of any coding changes. That will help them with their documentation and will help you with the coding.”