Risk and complication of anesthesia

Anesthesia - Risks and Complications

Although all types of anesthesia involve some risk, major side effects and complications from anesthesia are uncommon. Your specific risks depend on your health, the type of anesthesia used, and your response to anesthesia. Personal risk factors Your age may be a risk factor. In general, the risks associated with anesthesia and surgery increase in older people.

Certain medical conditions, such as heart, circulation, or nervous system problems, increase your risk of complications from anesthesia.

Some medicines can raise your risk of problems too. Make a list of all the prescription and over-the-counter medicines you take. And share your list with your doctors.

If you smoke, drink alcohol, or use illegal drugs, you may be more likely to have problems from anesthesia. It's important that you are honest when you talk with your surgeon and anesthesia specialist.

Anesthesia specialists, anesthesiologist and Anesthetist definition

Anesthesia specialists

Anesthesia specialists are responsible for making informed medical decisions to provide comfort and maintain vital life functions while you are receiving anesthesia and in recovery.

Anesthesia specialists include anesthesiologists and qualified nurse or dental anesthetists.

Anesthesiologist

Anesthesiologists are medical doctors who, after obtaining their medical degree and completing their internship, complete an additional 3 years of specialized training in an accredited anesthesiology residency program. They are certified by the American Board of Anesthesiology. As medical doctors, they have a wide range of knowledge about medications, medical care for diseases, how the human body works, and how it responds to the stress of surgery. 

Anesthetist

Most anesthetists are nurses who have graduated from an accredited nurse anesthetist program and who have been certified by the American Association of Nurse Anesthetists to become a certified registered nurse anesthetist (CRNA). Nurse anesthetists are advanced practice nurses with specialized skills in anesthesia administration. A nurse anesthetist is usually supervised by an anesthesiologist or a surgeon, although law and practice may vary by state.

ANESTHESIOLOGIST DIRECTED ANESTHESIA

Medical direction may apply to a single anesthesia service furnished by a CRNA or up to four concurrent anesthesia services. A physician who is directing the administration of anesthesia to four surgical members is not expected to be involved routinely in furnishing any additional services to other members. 

Addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic rather than continual monitoring of an obstetrical member would not substantially diminish the physician’s capacity to direct the CRNA services.

The medical directing anesthesiologist must document in the member’s medical record that all medical direction requirements have been met, including:

• Perform the pre-anesthetic examination and evaluation

• Prescribe the anesthesia plan

• Participate personally in the most demanding aspects of the anesthesia plan, including, if applicable, induction and emergence

• Ensure a qualified individual performs any procedure in the anesthesia plan he/she does not perform personally

• Monitor the course of anesthesia administration at frequent intervals

• Remain physically present and available for immediate diagnosis and treatment of emergency that may develop

• Provide indicated post-anesthesia care.

A physician may appropriately receive members entering the operating suite for the next surgery while directing concurrent anesthesia procedures. 

However, checking or discharging members in the recovery room and handling scheduling matters are not compatible with reimbursement to the physician for directing concurrent anesthesia procedures.

PCA - Patient Controlled Analgesia

Patient Controlled Analgesia

Patient controlled analgesia (PCA) services are reimbursable when they are administered by an anesthesiologist and are performed for the control of postoperative pain. A separately identifiable physician-recipient encounter should be reflected in the medical record documentation. PCA pumps are usually administered through an intravenous (IV) line or the PCA pump is connected to an epidural catheter line.

Daily management of a PCA pump through an IV line is disallowed. When an anesthesiologist provides the management of the PCA pump through an IV line, the anesthesiologist will be allowed a total of four units and will be considered a global payment for the management regardless of the number of days the recipient remains on the pump. Use procedure code 90784 for daily hospital management of intravenous patient-controlled analgesia.

The anesthesiologist should use the appropriate procedure code(s) when filing claims for a single injection or for an injection including catheter placement (epidural, subarachnoid, cervical, thoracic, lumbar, or sacral) when the PCA pump is connected to an epidural line. 

Placement of the epidural catheter and daily management of a subarachnoid or epidural catheter is not reimbursable on the same date of service. Daily management of a subarachnoid or epidural catheter is reimbursable on subsequent days.

Delivery of pain medication through intermittent injections, a regular infusion, or by a PCA pump is included in the management of an epidural line whether a registered nurse or a physician administers it. Additional units for a PCA pump that is connected to an epidural line is not separately reimbursable.

The global surgical reimbursement fee to the surgeon includes the management of a PCA pump for post-operative pain control and is not a separately reimbursable item. 

Similarly, a physician’s global medical service reimbursement includes the management of a PCA pump for recipients with chronic pain control or terminal cancer and is not separately reimbursable.

Biling and coding tip for anesthesia CPT codes

CPT Anesthesia Code List

00100–00222 Head

00100 Anesthesia for procedures on salivary glands, including biopsy

00102 Anesthesia for procedures on plastic repair of cleft lip

Coding Tip

Do not use code 00102 for procedures performed on the lip for conditions other than repair of cleft lip. For other, non-cleft lip repairs, see code 00300.

For cleft palate repairs, see 00172.

00103 Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery)

00104 Anesthesia for electroconvulsive therapy

Coding Tip

Code 00104 may be denied when multiple electroconvulsive therapy (ECT) is provided. ECT (CPT code 90871) is a noncovered service by Medicare. Therefore, when anesthesia is performed for this reason, it will be denied as such.

00120 Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified

00124 otoscopy

00126 tympanotomy

Coding Tip

Codes 00120–00126 each identify a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

00140 Anesthesia for procedures on eye; not otherwise specified

00142 lens surgery

00144 corneal transplant

Coding Tip

Codes 00140–00144 each identify a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

00145 Anesthesia for procedures on eye; vitreoretinal surgery

Coding Tip

Code 00145 is for a unilateral service. If the surgeon performs bilateral surgical services, use modifier 50 (bilateral procedure).

This code is appropriate to use on any vitreoretinal procedures requiring the same anesthetic management.

00160 Anesthesia for procedures on nose and accessory sinuses; not otherwise specified

00162 radical surgery

00164 biopsy, soft tissue

00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified

Coding Tip:

Diagnosis coding is important to substantiate coverage of code 00170.

Anesthesia provided in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting the teeth is noncovered by Medicare.

J codes J0120–J9999 Drugs Administered Including Oral and Chemotherapy Drugs

K codes K0001–K9999 Durable Medical Equipment Prosthetics, Orthotics, Supplies and Dressings (DMEPOS)

L codes L0100–L9999 Orthotic and Prosthetic Procedures, Devices

M codes M0064–M9999 Medical Services

P codes P2028–P9999 Pathology and Laboratory Services

Q codes Q0035–Q9999 Miscellaneous Services (Temporary Codes)

R codes R0070–R9999 Radiology Services

T codes T1000–T9999 Medical Services

S codes S0009–S9999 Commercial Payers (Temporary Codes)

V codes V2020–V9999 Vision, Hearing and Speech- Language Pathology Services