Anesthesia Coding

Anesthesia coding will be the focus of this “Spotlight on CPT” article.  Correct assignment of the appropriate anesthesia code for the service that was provided will require that coding professionals utilize information found in the CPT manual.  Additionally, there are specific modifiers and add-on codes applicable to anesthesia codes, which we will review.

Let’s begin with the anesthesia codes themselves.  These can be found by using the Index in the CPT Manual under the term “anesthesia”.  In most circumstances, there is not a direct one-to-one match between a surgical procedure and its corresponding anesthesia code.  Instead, the anesthesia codes are more generic in nature.  For example, any procedure done on the lower anterior wall of the abdomen falls under anesthesia code 00800.  However, there are some instances where the correlation is very specific with a one-to-one match as in the case of a panniculectomy procedure, which would be coded to 00802.

As illustrated above, coding professionals will need to use appropriate procedural terminology in order to arrive at the correct anesthesia CPT code.  It will be equally important to employ their knowledge of anatomy to arrive at the correct code(s).  For example, if a patient was having an inguinal hernia repair, a coder will need to recognize that this is a hernia repair of the lower abdomen coded to 00830 and not the upper abdomen, which would code to 00750. 

Four add-on codes can be assigned under certain circumstances along with an anesthesia code.  These codes are “Qualifying Circumstance” codes and indicate that the anesthesia service was provided in a particularly difficult situation.  This could be due to the patient’s age (either very young or old), hypothermia, hypotension, or an emergency.  An emergency is deemed to exist if treatment delay would result in increased the risk to patient.  More than one of these codes could apply to the encounter and all that apply should be coded. These codes are:

    +99100     Anesthesia for patient of extreme age, younger than 1 year and older than 70
    +99116     Anesthesia complicated by utilization of total body hypothermia
    +99135     Anesthesia complicated by utilization of controlled hypotension
    +99140     Anesthesia complication by emergency conditions

Again, the aforementioned codes are to be assigned in addition to the base anesthesia code for the procedure performed.  For example, if an 82 year-old male was involved in an automobile accident and was diagnosed with a liver hemorrhage for which he underwent an emergency partial hepatectomy, the anesthesia codes would be 00792 with qualifying circumstance add-on codes +99100 (for his age) and +99140 (for the emergency).

Anesthesia codes also have their special modifiers.  These are physical status modifiers and are assigned along with the anesthesia codes.  These physical status modifiers are a way to identify the level of complexity associated with the anesthesia service that was provided.  There are six physical status modifiers as noted below:

    P1-normal healthy patient
    P2-patient with mild systemic disease
    P3-patient with severe systemic disease
    P4-patient with severe systemic disease which is a constant threat to life
    P5-moribund patient who is not expected to survive without the operation
    P6-declared brain-dead patient whose organs are being removed for donor purposes

Keeping these concepts in mind will help coding professionals accurately report anesthesia services.

Now, light has been shed on anesthesia coding.


About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.