Anesthesia Coding Alert

Know how many extra units you can claim for each situation.

Although not every payer will add to your reimbursement for physical status modifiers, they’re good for tracking purposes and help show why your anesthesia providers might spend longer on a case than expected. The trick is knowing how to distinguish one level from another, because the American Society of Anesthesiologists (ASA) doesn’t fully define the terms. Instead, their use is based on clinical decisions the anesthesia provider makes for each patient.

Providers assign a physical status modifier during the pre-anesthesia assessment. Keep these examples in mind as a way to gauge your own cases:

• P1 (A normal healthy patient) is generally a healthy patient who presents with minimal risks.
• P2 (A patient with mild systemic disease) applies to patients with conditions such as controlled diabetes.
• P3 (A patient with severe systemic disease) points to conditions such as severe diabetes with vascular complications, stable angina, or lupus. The patient has s systemic disease that could kill him, but he’s expected to do well in surgery.
• P4 (A patient with severe systemic disease that is a constant threat to life) represents a patient whose systemic disease is a higher-level threat. He isn’t expected to die during the perioperative period, though having the disease means it wouldn’t be totally unexpected if it happened. These patients can include those with unstable angina or congestive heart failure.
• P5 (A moribund patient who is not expected to survive without the operation) represents a very high risk, sick patient or one in a trauma situation. Modifier P5 can apply to patients with severe conditions such as a ruptured aneurysm or major cerebral trauma with rapidly increasing intracranial shock.
• P6 (A declared brain-dead patient whose organs are being removed for donor purposes).

Some of the P modifiers carry base unit values that correlate with the additional risk involved in anesthesia care for the patient. If the payer in question recognizes P modifiers, know how many base units you can claim:

• P1 -- 0 units
• P2 -- 0 units
• P3 -- 1 unit
• P4 -- 2 units
• P5 -- 3 units
• P6 -- 0 units.

Assigning physical status modifiers is very individualized and the information you find from one place to another might conflict. In addition, some providers are better at documenting conditions to support physical status than others. If you have questions, check with your anesthesiologist or nurse assistant for clarification.