Coding an Operative Report Part II: Anesthesia

[Music]

foreign

we will discuss steps to solving a

medical coding exam case study but first

I want to introduce you to the team

first up Mr Sandeep

Mr Sandeep coming to you live from Abu

Dhabi he is an AMCI co-lead instructor

next up Miss Eva

coming to you live from the state of

Florida she's also a co-lead instructor

and the intern coordinator and finally

myself Mrs J I'm the curriculum director

at AMCI

now

let's meet the AMCI interns we have Miss

anubama

followed by

Miss Carla

Miss Courtney

Miss Dolly Miss Vivian and Miss Melissa

goals of the presentation

we will extract the correct codes from

anesthesia documentation

now let's talk about how to solve a

multiple choice case study scenario the

AMCI wave for the board exam this is how

we do it we teach you to highlight your

key terms and this key on the right

tells you the colors that you should use

and for what a yellow highlighter should

be used for diagnoses all diagnoses

signs and symptoms

the green will be for procedures so if

you have a green highlighter the green

will be used to highlight only

procedures and pink these are inclusive

or bundled items all right

once you've done your highlighting

you're going to have to document your

inventory that your procedures diagnoses

and select a primary code which

diagnosis is primary which procedure is

primary then you're going to review all

pertinent guidelines

and finally the code that best matches

your inventory list is often the correct

code or a code that is pertinent to a

guideline that will be your best code

all right so here are some do Nots when

you're highlighting you can kind of get

discombobulated so we've compiled some

things that you don't even have to

highlight

number one don't highlight things

observed by The Physician because you

cannot code for them

number two

don't highlight closures if a provider

or surgeon is closing up a surgical site

there's no need to highlight it however

if it involves a skin procedure or skin

defect closure you may definitely have

to code that so if it's closing a

surgical site other than skin defects or

wounds or lesions

you do not code it or highlight it also

you don't highlight bleed control

hemostasis because that's pretty

customary and it's bundled into the

procedure code you don't highlight

drains irrigation of the surgical site

nope and you don't highlight

installation and removal of clamps intro

cars because that these are used to open

up or maintain the surgical or operative

site so the physician can view what

they're doing particularly if it's an

open procedure also you don't highlight

dressings and finally you do not

highlight surgical wrists now that we've

gotten that out of the way I think

you're ready to get started and I'm

going to hand it over to Mr Sandeep all

right Mr Sandeep take it away

my apologies Miss Eva is going to begin

by reading the first scenario take it

away Miss Eva

now uh we're gonna start with anesthesia

I will read the first scenario Mr

Sandeep and afterwards I'll give them

over to you so anesthesiologists

personally performed case anesthesia

time

1304-1341 physical status three

pre-operative diagnosis

rll long cavity possible C8 of lung

post-operative diagnosis it's a right

lower love lung cancer carcinoma

procedure bronchoscopy anesthesia

monitor anesthesia care procedure

description with the patient under

satisfactory anesthesia a flexible fiber

optic bronchoscope was introduced via

Aura cavity in advance past the larynx

for visualization of the bronchus cells

washing were obtained and sent to

pathology the bronchoscope was then

removed patient tolerated procedure well

cell washing obtained from the right

lower left were confirmed by pathology

as malignant carcinoma I am so sorry

coders I forgot to read my answers first

hey zero zero five twenty aaqs P3

c34.3

b00522 a a q s p three

c34.3

c005288qsp3

c34.3 and D 0 0 5 40 a a q s b 3 C 34.3

what CPT and icd-10-cm codes are

reported for the anesthesiologist what

is the time reported for this Services

good as you have uh two minutes Mr

Sandeep

we will give them two to two and a half

minutes time okay they're all yours

and that is two minutes 30 seconds

quarter and from what I see from the

charge around 100 percentage of of the

coders have said the correct answers

what a way to start this beautiful

evening

and you guys are like awesome awesome

Anastasia coders okay still it's my duty

to go ahead and

let you all know how I arrived into the

correct answer for this one let's have

our key versus the FDR for Anastasia you

have to check whether it's a surgical

procedure uh well we have to find the

time provider type physical status the

qualifying circumstances and only use of

general anesthesia or the Hawks these

are the keywords anesthesiologists

personally performed uh the case so

what's the modifier going to record us

for this one when the anesthesiologists

personally performed the case

let's make this final session

Interactive

let me have a look into the chat

what modifier do we apply well

anesthesiologists are personally

performed

The annotation service

yes

it is going to be a

and anesthesia time is 13 uh zero four

to thirteen forty one

the post-operative diagnosis is right

lower lobe carcinoma the procedure which

is performed is bronchioscopy and

anesthesia which is given is a monitored

anesthesia care

and quickly what will be the mounted and

social care modifier

quickly quotes

yes I said you guys are an awesome

Anastasia quotas Qs modifier that is

what we apply when a monitor and such a

care has been given

and we are having P3 status physical

status modifier as well here

so in the description of the procedure a

bronchoscope was introduced via oral

cavity and proxycopy was was done

so the correct answers as you all said

for this scenario is going to be option

A

and let's look how we arrived into the

option A these are these are our code

options what will be the anesthesia time

for this scenario

if you click or this anesthesia time for

this one

okay

I got the first first response okay

uh the first one I'm asking about the

Anastasia time next I will ask about

anesthesia unit so now I just want the

Anastasia time for this one

foreign

for this one is going to be 37 minutes

we'll find the difference between the

1304 to 1341 and that is going to be 37

minutes and next question what will be

the Anastasia unit

foreign

for this one is going to be two units

how we got that we'll be dividing the 37