Undergoing a surgical procedure or medical treatment for a serious disorder can be quite stressful. If you are scheduled for a surgery, you may have several questions or concerns in your mind about anesthesia. Anesthesia is the administration of medications that prevents patients from experiencing or feeling pain during a surgery or other medical procedure. Skilled anesthesiologists administer the drugs via machines that measure the specific amount necessary to keep the patient out for the surgery. While you’re under anesthesia, the anesthesiologist monitors your body’s vital functions and manages your breathing. Reports suggest that each year millions of people undergo some form of medical treatment requiring anesthesia. In hospitals, an anesthesiologist and a certified registered nurse anesthetist (CRNA) work together during the procedure. Anesthesia care is not confined to a surgery alone. The process also refers to activities that take place both before and after an anesthetic is given to a patient. Anesthesiology medical billing and coding is a complex task. A higher level of coding skills is essential to report anesthesia services as there are many complexities involved in coding and billing for this specialty. That’s why most providers prefer to outsource the task to a reputable medical billing and coding company with considerable experience in the field.
Here are some frequently asked questions and answers about anesthesia –
Q: What is anesthesia and how does it work?
A: Anesthesia is a state of consciousness or sedation achieved by using medications and/or non-pharmacologic adjuncts (therapy that does not involve the use of drugs), which reduce or block pain sensation of a part or the entire body. The procedure prevents patients from feeling pain during surgery and is used to increase comfort and safety during medical or surgical procedures. Depending on the type of pain relief needed, doctors deliver anesthetics by injection, inhalation, topical lotion, spray, eye drops, or skin patch. Anesthesia may also cause full or partial amnesia so that patients may not remember what is going on with them and around them.
Q: What are the types of anesthesia?
A: There are different types of anesthesia which include –
- Local Anesthesia – Often used for minor surgeries and outpatient procedures (when patients come in for an operation and can go home that same day), local anesthetic is a medication that numbs the treated area. This type of anesthetic agent is given to temporarily stop or reduce the pain sensations in and around the treated area. It does not affect memory, recall of events or a patient’s ability to breathe on his or her own. Patients may generally remain conscious during a local anesthetic.
- Regional Anesthesia – Regional anesthesia provides a more generalized area of numbness. In this type, an anesthetic drug is injected near a cluster of nerves, numbing a larger area of the body (such as below the waist). Most people who are given regional anesthesia are deeply sedated or asleep for the procedure. Types of regional anesthesia include – Epidural (extradural) anesthesia, Spinal anesthesia (subarachnoid block) and Peripheral nerve blockade.
- General Anesthesia – General anesthesia uses a combination of intravenous drugs and inhaled gasses (anesthetics), to induce unconsciousness during surgery. The medicine is either inhaled through a breathing mask or tube, or given through an intravenous (IV) line.
Sedatives (to make you sleepy) and analgesics (to ease the pain) may also be used as part of the anesthesia process. However, the decision as to which specific type of anesthesia will be used may mainly depends on several factors like – the type and area of the surgery (a patient is scheduled for), specific medical condition of the patient, personal medical history of the patient, patient age and weight, allergic reactions patient suffers from and the surgeon’s or anesthesiologist’s preferences. Regardless of the type of anesthesia administered, patients will be monitored closely. The anesthesiologist will monitor the breathing and blood oxygen levels, heart rate, blood pressure, EKG and temperature levels in detail.
Q: What are the common side effects of the procedure?
A: Patients will most likely feel disoriented and confused when waking up after the surgery. Other related side effects include – chills or shakiness, dizziness, headache, nausea or vomiting, sore throat (if a tube was used to help with breathing), blood pressure changes and pain. However, these side effects are usually mild, short-lived and treatable.
Q: What are the potential risks associated with the procedure?
A: Nowadays, administering anesthesia is very safe as people (even those with serious health conditions) are able to undergo the same without any serious problems. However, in some rare cases, this procedure can cause complications like breathing problems, allergic reactions to medications and abnormal heart rhythms. The potential risks depend on the kind of procedure, the condition of the patient, and the type of anesthesia used. Be sure to discuss with your doctor, surgeon, and/or anesthesiologist in advance about any concerns. Specific conditions that can increase your risk of complications during surgery include –
- Usage of medications, such as aspirin, that can increase bleeding
- Other medical conditions involving your heart, lungs or kidneys
- Obstructive sleep apnea
- History of heavy alcohol use
- High blood pressure and diabetes
Q: What do anesthesiologists do?
A: Anesthesiologists are physicians who carefully monitor patients throughout the surgery and during recovery. They use electronic devices that constantly display patients’ blood pressure, blood oxygen levels, heart function, and breathing patterns.
Q: Which imaging exams may require anesthesia or sedation?
A: Patients undergoing imaging exams like MRI may need anesthesia or sedation in order to stay relaxed and lie motionless. Anesthesia may be generally administered to –
- Patients who are claustrophobic or who have medical conditions that make it difficult or impossible to remain motionless for the exam
- Young infants, children and adolescents who are incapable of remaining motionless and understanding directions
In some interventional radiology procedures, such as angiography, angioplasty, biopsies and embolization procedures, both local anesthetic (to numb the skin where a needle or catheter will be used) and deep sedation to help the patient stay calm and relaxed during the procedure will be used.
Q: Does Medicare cover anesthesia?
A: Patients who receive anesthetics for a covered medical procedure, whether as an inpatient at a hospital or as an outpatient at a freestanding ambulatory surgical center, Medicare Part A and Part B may cover these services. However, to qualify for Medicare coverage, your anesthesia treatment must be medically necessary and administered by a provider who accepts Medicare assignment.
Q: What are the medical codes used for documenting anesthetic procedures?
A: Anesthesiologists who administer the medicines during the surgery are reimbursed for the services provided to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing services offered by reputable companies can help physicians use the correct codes for their medical billing process.
The following CPT codes are relevant with regard to anesthetic procedures –
- 00100-00222 – Anesthesia for Procedures on the Head
- 00300-00352 – Anesthesia for Procedures on the Neck
- 00400-00474 – Anesthesia for Procedures on the Thorax (Chest Wall and Shoulder Girdle)
- 00500-00580 – Anesthesia for Intra-thoracic Procedures
- 00600-00670 – Anesthesia for Procedures on the Spine and Spinal Cord
- 00700-00797 – Anesthesia for Procedures on the Upper Abdomen
- 00800-00882 – Anesthesia for Procedures on the Lower Abdomen
- 00902-00952 – Anesthesia for Procedures on the Perineum
- 01112-01173 – Anesthesia for Procedures on the Pelvis (Except Hip)
- 01200-01274 – Anesthesia for Procedures on the Upper Leg (Except Knee)
- 01320-01444 – Anesthesia for Procedures on the Knee and Popliteal Area
- 01462-01522 – Anesthesia for Procedures on the Lower Leg (Below Knee)
- 01610-01680 – Anesthesia for Procedures on the Shoulder and Axilla
- 01710-01782 – Anesthesia for Procedures on the Upper Arm and Elbow
- 01810-01860 – Anesthesia for Procedures on the Forearm, Wrist, and Hand
- 01916-01936 – Anesthesia for Radiological Procedures
- 01951-01953 – Anesthesia for Burn Excisions or Debridement Procedures
- 01958-01969 – Anesthesia for Obstetric Procedures
- 01990-01999 – Anesthesia for Other Procedures
In addition, CPT Codes for Qualifying Circumstances for Anesthesia (maintained by the American Medical Association) include –
- 99100 – Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure)
- 99116 – Anesthesia complicated by utilization of total body hypothermia (99116 are not allowed with anesthesia codes 00561, 00562, 00563 and 00567)
- 99135 – Anesthesia complicated by utilization of controlled hypotension (99135 are not allowed with anesthesia codes 00561, 00562, 00563 and 00567)
- 99140 – Anesthesia complicated by emergency conditions
Q: What patient preparations are required for the anesthetic procedures?
A: Before undergoing the procedure, the anesthesiologist will evaluate the patient’s medical condition in detail and formulate an anesthetic plan that takes their physical condition into account. Patients will be asked questions about previous medical history and lifestyle habits, medicines consumed (including over-the-counter and herbal supplements), allergic reactions to food, medications or contrast materials and family history of problems with anesthesia or any medical conditions. Prior to your procedure, blood tests may be conducted to analyze liver and kidney functioning. A physical exam may also be performed. Women should always inform their physician or technologist if they are pregnant or if they are breastfeeding their baby. Some of the most important preparation tips include –
- Do not eat or drink anything for up to eight hours before receiving sedation or anesthesia. However, patients can consume routine medicines for heart disease, blood pressure, or asthma before receiving anesthesia with a small sip of water.
- The time period for fasting may differ based on the procedure, medical history, a patient’s age, the hospital, or institution guidelines.
Q: What will patients experience before and after receiving anesthesia?
A: Before the Procedure
In most cases, patients who receive anesthesia are attached to specialized devices that monitor heart rate and other vital functions of the body. Patients, who receive a general anesthetic, will be unconscious for the entire procedure under the direct care of anesthesiologists. On the other hand, if patients are scheduled to receive sedation, sedatives will usually be administered through an intravenous (IV) catheter. They may feel slight pressure or a sharp pinch when the catheter is inserted, but will not experience any serious discomfort.
After the Procedure
In the case of local anesthesia, patients can leave the hospital soon after the procedure (within a few hours after the procedure, which again depends on the type of procedure administered). For general anesthesia, patients will remain in the recovery room for a longer period of time, until they attain a normal level of consciousness.
However, it may take up to 24 hours for the medication effect to completely leave your body. Following an anesthetic or sedation, patients should not drive or operate equipment for at least 24 hours.
Pediatric patients may have varied responses to sedatives and anesthesia, and will be able to resume their normal activity within six to eight hours. Some children may become agitated, inconsolable or restless during or after sedation, whereas others may feel sleepy and unsteady on their feet for the whole day. However, children should be monitored by a responsible adult for 12 to 24 hours after being sedated.