Anesthesia Coding Alert

Latest on Physical Status Modifiers (P1-P6) from Codify's Anesthesia Coder  

Mind Your P Modifiers or Leave Money on the Table

Use 6 Levels to Define Patient's Status

The American Society of Anesthesiologists (ASA) developed physical status modifiers to allow coders to distinguish between different levels of complexity of anesthesia service. These levels are based on the patient's condition, as follows:
  P1 – Normal healthy patient P2 – Patient with mild systemic disease P3 – Patient with... ...to read the full article and understand the accurate usage of Physical Status Modifiers, subscribe to Codify's Anesthesia Coder. Take a FREE Trial Today.

One area of coding that is unique to anesthesia is the use of physical status modifiers (P modifiers) for each patient, which are appended on claim forms after the procedure code. These modifiers distinguish between different levels of complexity of anesthesia service provided, depending on the patient's circumstances, but the distinctions between different modifiers can vary somewhat among providers. Although it's primarily up to the physician to determine which P modifier to use in a particular case, coders still should check the record's documentation and be familiar with local guidelines to ensure that they assign codes correctly.

Know the Differences Among Modifiers

CPT's anesthesia section lists six physical status modifiers which are consistent with how the American Society of Anesthesiologists (ASA) ranks patient status. Many patients fall into categories P1 (A normal healthy patient) or P2 (A patient with mild systemic disease); these two modifiers are self-explanatory and don't require additional documentation. But the records of patients who are classified as P3 (A patient with severe systemic disease) P4 (A patient with severe systemic disease that is a constant threat to life) or P5 (A moribund patient who is not expected to survive without the operation) do need documentation supporting their status. This is because insurance carriers may reimburse at a higher rate due to the risk factors associated with treating these patients. Additional reimbursement does not come into play with patients classified as P6 (A declared brain-dead patient whose organs are being removed for donor purposes).

The only reason we get extra value for patients classified as P3-P5 is the added difficulty factor in trying to ensure they survive the surgery " explains Robin Fuqua CPIC a coder for anesthesiologist Jose G. Veliz MD in Escondido Calif. "Nothing extra is paid for P6 because the patient has been ruled clinically dead. [...]

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