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Anesthesia Modifiers and Qualifying Circumstances codes (LO# 2, 3, 4)
Slide 1. Hello. When reporting Anesthesia services, there are special modifiers,
known as Physical Status Modifiers and add-on codes called Qualifying
Circumstances codes that you must know about and use appropriately.
Slide 2. PHYSICAL STATUS MODIFIERS
The American Society of Anesthesiologists (ASA) established six levels of
measuring the physical condition of a patient with regard to the administration of
anesthesia. Each level, identified by the letter “P” and a number from 1 to 6,
denotes issues that may increase the complexity of delivering anesthetic services
and are measured at the time the anesthetic is about to be administered. The
anesthesiologist is the professional who determines the correct physical status
modifier. However, you, as the coding specialist, must be certain to look for the
information and include it on the claim form.
Physical status modifiers are mandatory with every code from the
Anesthesia section of the CPT book and are placed directly after the five-digit
CPT code (with a hyphen between the two). (Note: Physical status modifiers are
different from, and have nothing to do with, the regular CPT and HCPCS
modifiers shown in Appendix A of the CPT book.)
Following are the physical status modifiers that are to be used only with
anesthesia codes:
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Slide 3. P1 signifies a normal healthy patient. Modifier P1 indicates that the
patient to whom the anesthetic was given had no medical concerns that would
interfere with the anesthesiologist’s responsibilities for keeping the patient
sedated and safe.
Slide 4. P2 reports the patient has a mild systemic disease. When a patient has a
disease that may affect the general workings of the patient’s body, it must be
taken into consideration with regard to administering anesthesia. However, if the
disease is under control, then its involvement is less of a concern.
Slide 5. P3 reports that the patient has a severe systemic disease. In this case,
the patient’s disease is serious throughout his or her body and is an important
factor for the anesthesiologist to contend with, in addition to the reason for the
procedure.
Slide 6. P4 indicates that the patient has severe systemic disease that is a
constant threat to life.
Modifier P4 describes any patient having medical problems that have invaded or
affected multiple systems of the body. The large number of issues regarding the
effects of the disease, along with existing medications and treatments that have
been ongoing in the patient’s system, and the potential interactions with the
anesthetic make it a very complex case.
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Slide 7. P5 identifies a moribund patient who is not expected to survive without
the operation. This is a life or death situation, but not necessarily an emergency.
In such cases, the patient is in critical condition, and there are serious medical
complications that make administering anesthesia more challenging.
Slide 8. P6 reports services provided to a patient who has been declared braindead patient whose organs are being removed for donor purposes. This modifier
is provided by the ASA for use with brain-dead patients. Individuals in this
condition need to have anesthesia administered to slow bodily functions and give
the transplant team time to harvest the viable organs.
Slide 9. Additional explanation can be found in the guidelines on the pages
directly before the Anesthesia section, under the subhead Anesthesia
Modifiers, Physical Status Modifiers in your CPT book. You can always use
these guidelines to help support your learning here and as a memory booster
later on.
Slide 10. QUALIFYING CIRCUMSTANCES
Sometimes special circumstances, also called qualifying circumstances, cause
the anesthetic process to be more complicated than usual. In these cases, a
second—or add-on—code is used to identify that circumstance.
The available add-on codes for qualifying circumstances are
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Slide 11. +99100 Patient of extreme age . . . younger than 1 year or older than
70 years. This add-on code is not to be used when the code description already
includes an age definition, such as codes 00326, 00834, or 00836.
Slide 12. +99116 Anesthesia complicated by total body hypothermia.
Hypothermia is defined as extremely low body temperature, below 36.1°C (97°F).
Because monitoring vital signs, including body temperature, is an important part
of the anesthesia process, a very low body temperature would make the safe
administration of anesthesia more complicated.
Slide 13. +99135 Anesthesia complicated by controlled hypotension.
Hypotension is defined as abnormally low blood pressure. The critical connection
between blood pressure and heart rate makes this situation very intricate for the
anesthesiologist.
Slide 14. +99140 Anesthesia complicated by emergency conditions. An
emergency is characterized as a situation in which the patient’s life, or an
individual body part, would be threatened if there were any delay in providing
treatment. In such a case, the anesthesiologist may not have the time to get the
patient history or other information necessary to do his or her job most efficiently
or effectively.
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Slide 15. It is important to remember to take coding one step at a time. It is
complex and challenging and it takes time to learn. So, please, if you have any
questions… ask your instructor.