AAPC-CPC Certified Professional Coder - Set 5 - Part 3

Correct Answer: Regional anesthesia

The Medicare manual orders anesthesia services from least to most intense as local or topical anesthesia, moderate (conscious) sedation, regional anesthesia and general anesthesia. Regional anesthesia therefore sits between moderate sedation and general anesthesia. Option a is incorrect because the manual mentions it only as something moderate sedation does not include, and it is not one of the four listed levels. Option b is incorrect because it is the least intense service on the continuum and sits before moderate sedation, not between moderate sedation and general anesthesia. Option c is incorrect because the manual does not list it as a step on the continuum; it separates monitored anesthesia care from moderate sedation.

Correct Answer: Moderate sedation code is not reported; no separate payment

Local or topical anesthesia is lower in intensity than moderate sedation on the continuum. When the physician performing the procedure provides only that level, the moderate sedation code should not be reported and the A/B MAC allows no separate payment. Option a is incorrect because the manual describes no reduced-rate payment here; when anesthesia is lower in intensity than moderate sedation, the A/B MAC allows no separate payment at all. Option b is incorrect because monitored anesthesia care is a distinct service that must meet its own criteria, and local anesthesia given by the proceduralist does not meet them. Option d is incorrect because payment modifiers belong to anesthesia time-based claims, and the manual does not use them to turn local anesthesia into a reportable moderate sedation service.

Correct Answer: Medical necessity

CMS recognizes monitored anesthesia care as a payable service if medically reasonable and necessary. Issues of medical necessity are addressed by national CMS policy and local contractor coverage policies. Option a is incorrect because the guidance lists sedatives, analgesics, hypnotics, or other agents as acceptable means, so the agent chosen does not set coverage. Option c is incorrect because payment modifiers show which rate applies, such as personally performed or medically directed, and come after coverage has been settled. Option d is incorrect because time is reported on the claim and converted into time units, but it does not decide whether the service is covered.

Correct Answer: Moderate sedation reported with a procedural service

The Medicare manual states that moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care. Moderate sedation is therefore not part of monitored anesthesia care, while the pre-anesthetic, prescription and postoperative elements are. Option a is incorrect because the manual lists prescription of the anesthesia care required among the components that monitored anesthesia care also includes. Option b is incorrect because the manual names provision of indicated postoperative anesthesia care as one of the services monitored anesthesia care includes. Option d is incorrect because the manual expressly includes performance of a pre-anesthetic examination and evaluation as part of monitored anesthesia care.

Correct Answer: Monitoring to anticipate a possible need for general anesthesia

Monitored anesthesia care involves patient monitoring sufficient to anticipate the potential need to administer general anesthesia during a surgical or other procedure, including watching vital physiological signs for adverse reactions. Option a is incorrect because CMS recognizes the service as payable only if medically reasonable and necessary, with medical necessity addressed by national CMS policy and local contractor coverage policies. Option b is incorrect because monitored anesthesia care is given so that the patient remains responsive and breathes on their own, which is the opposite of this. Option c is incorrect because the pre-anesthesia evaluation is just one listed component, and the service also covers intraoperative monitoring and indicated postoperative anesthesia care.

Correct Answer: One of the payment modifiers

Medicare states that QS is for informational purposes and that providers must report actual anesthesia time and one of the payment modifiers on the claim. The payment modifier shows the payment rate the service meets. Option b is incorrect because GC is reported by a teaching physician to show a resident performed the service, which does not describe a CRNA's monitored anesthesia care. Option c is incorrect because time units are calculated by the A/B MAC from the actual anesthesia time in minutes reported on the claim, not by the biller. Option d is incorrect because the guidance does not call for a second informational modifier; QS is already informational, and the missing element is a modifier that shows the payment rate.

Correct Answer: Reasonable and necessary, and legally authorized in the State

Medicare pays for medical or surgical services furnished by CRNAs when the services are reasonable and necessary and the CRNA is legally authorized to perform them in the State where they are furnished. Option a is incorrect because actual anesthesia time belongs on anesthesia claims so time units can be computed, and it is not a condition for medical or surgical services. Option b is incorrect because QS is informational and identifies monitored anesthesia care; it is not a stated condition for paying a CRNA's medical or surgical service. Option d is incorrect because medical direction is a payment-rate concept for anesthesia services; the guidance for CRNA medical or surgical services does not make direction by a physician a condition.

Correct Answer: CRNAs and anesthesiologists' assistants

Medicare guidance states that, for payment purposes, "qualified nonphysician anesthetist" refers to both certified registered nurse anesthetists (CRNAs) and anesthesiologists' assistants, unless otherwise separately discussed. Option a is incorrect because teaching physicians appear in the guidance only in connection with the GC modifier for services performed by a resident, not within the nonphysician anesthetist term. Option b is incorrect because residents are mentioned only as performing services under a teaching physician's direction with the GC modifier, and the payment definition does not name them. Option c is incorrect because anesthesiologists are physicians, and the term refers to nonphysician practitioners, so it does not cover them even when an assistant works under their direction.

Correct Answer: CRNA service without medical direction by a physician

Medicare billing instructions list QZ as the CRNA service modifier for services furnished without medical direction by a physician. QX covers medically directed services, and QS is the informational monitored anesthesia care modifier. Option a is incorrect because QS carries that description, and the manual treats it as informational, whereas QZ is one of the payment modifiers reported on the claim. Option c is incorrect because that wording defines QX, the sibling payment modifier for medically directed services, which is the opposite of the QZ situation. Option d is incorrect because this is a claim situation addressed in the general billing instructions for separate claims or line items, not the meaning of QZ, QX or QS.

Correct Answer: Names of procedures and medically directed anesthetists

During periodic sample reviews of claims for medical direction of four or fewer concurrent procedures, A/B MACs may request documentation of the names of procedures performed and the names of the anesthetists medically directed. Option b is incorrect because consent forms are not named in the guidance as part of the sample claim review for medical direction of concurrent procedures. Option c is incorrect because specialty codes are how the provider file identifies a CRNA or anesthesiologist's assistant, not what the physician submits during the sample review. Option d is incorrect because the guidance describes a pre-anesthetic examination within monitored anesthesia care but does not list it as the documentation requested in this review.