Certified Anesthesia and Pain Management Coder (CANPC)
The Certified Anesthesia Coder exam was developed by a team of leading anesthesia coding professionals. Those coders with sufficient experience and expertise in anesthesia coding are encouraged to sit for the CANPC exam.
The CANPC examinee will be tested on:
Selecting the appropriate CPT codes for surgical cases and cross walking to the appropriate ASA code
Proper use of modifiers common for anesthesia cases
Determining time units and total units for anesthesia cases
Rules and regulations of Medicare billing including (but not limited to) incident to, teaching situations, shared visits, consultations and global surgery
Coding per NCCI, ICD-10-CM, CPT Modifiers and both the 1995 and 1997 Documentation Guidelines
Anatomy and physiology
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Reviewed by a Anesthesia Steering Committee:
Lindsay Anne Jenkins, CPC, COC, CPC-I, CIRCC, CANPC, CRNA
Lisa Zigarovich, CPC, CANPC
Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC, CPMA
Michele Deleonibus, CPC, CANPC
Specialty exams aptly measure preparedness for “real-world” coding by being operative/patient-note based. In addition to questions regarding the correct application of ICD-10-CM, CPT®, HCPCS Level II and modifier coding assignments, examinees will also be tested on specialty-specific coding and regulations.
Must schedule examination four weeks in advance
Must have current AAPC membership
While there is no requirement, we strongly recommend that the candidate has at least two years of experience in the specialty. Please be aware that these are difficult, high-level examinations not meant for individuals with little, limited or no coding experience.
Examinees that pass a Specialty certification examination will receive recognition in the Healthcare Business Monthly within three months of their examination date and will receive a diploma suitable for framing.
Anesthesiology coding is a unique specialty within the world of medical coding, and it requires a special skill-set and mastery of both the CPT coding paradigm and the ASA coding system. They must know surgical and obstetric coding rules in addition to the anesthesiology regulations. Add to that the expertise needed to code pain management procedures which encompasses E&M services, radiology, and surgical coding, and you have a very esoteric job description requiring advanced anesthesia coding training, mentoring, hands-on experience, and continuous updating and supervision.
Anesthesiology and Pain Management Coding Background
Managed by nationally recognized anesthesiology coding and pain management coding expert.
Decades of anesthesiology coding and pain management coding experience in academic and private practices.
Team of highly experienced Certified Coders specializing in anesthesiology and pain management..
The Anesthesiology and Pain Management Coding Need Well trained anesthesiology coding experts are difficult to find, expensive to recruit, and costly to maintain.
Anesthesiology coding is complex and the regulations change frequently, making accuracy and compliance daily challenges.
There are no “practice runs” when submitting your claims; they must be accurate the first time. The legal and financial risks of upcoding or undervaluation errors are enormous.
Few anesthesiology and pain management coders are Certified, a symbol of quality coding.
There is a national shortage of coders with extensive anesthesiology coding experience.
Coder turnover creates cash flow peaks and valleys.
The Coding Network’s Anesthesiology and Pain Management Coding Solution
In 2018, anesthesia coders like you will have to adapt to massive changes in coding terminologies and coding guidelines. ProfEdOnDemand.com, with its invaluable anesthesia coding webinars, is the one-stop solution to all your coding-related queries. Get the answers you need, based upon anesthesia coding guidelines. With over 12 years of experience, ProfEdOnDemand.com has successfully built a reputation. We provide solutions to the numerous coding, billing, and practice concerns with anesthesia conferences. With our anesthesia coding training, you will learn about major anesthesia coding changes in 2018 straight from the experts.
Anesthesia Billing Guidelines
• Anesthesia – the introduction of a substance into the body by external or internal means that causes loss of sensation (feeling) with or without loss of consciousness.
• Anesthesiologist – a physician (M.D. or D.O.) who specializes in anesthesiology.
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.
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.
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.
• Certified Registered Nurse Anesthetist (CRNA) – a registered nurse who is licensed by the State in which the nurse practices. The CRNA must be certified by the Council on Certification of Nurse Anesthetists or the Council on Re-certification of Nurse Anesthetists or the CRNA must have graduated within the past 24 months from a nurse anesthesia program that meets the standards of the Council on Accreditation of Nurse Anesthesia Educational Programs and be awaiting initial certification.
• Concurrent Medically Directed Anesthesia Procedures – concurrency is defined with regard to the maximum number of procedures that the physician is medically directing within the context of a single procedure and whether these other procedures overlap each other. The physician can medically direct two, three or four concurrent procedures involving qualified CRNAs.
• Medical Direction – occurs when an anesthesiologist is involved in two, three or four concurrent anesthesia procedures or a single anesthesia procedure with a qualified CRNA.
• Medical Supervision – occurs when an anesthesiologist is involved in five or more concurrent anesthesia procedures.
Personally Performed Anesthesia
We will determine the applicable allowable charge, recognizing the base unit for the anesthesia code and one time unit per 15 minutes of anesthesia time (unless otherwise stated) if:
• The physician personally performed the entire anesthesia service alone;
• The physician is continuously involved in a single case involving a student nurse anesthetist; or,
• The physician and the CRNA are involved in one anesthesia case and the services of each are found to be medically necessary upon appeal. Documentation must be submitted by both the CRNA and the physician to support payment of the full fee for each of the two providers through our appeal process. The physician reports the “AA” modifier and the CRNA reports the “QZ” modifier for a nonmedically directed case.
We will determine payment for the physician’s medical direction service on the basis of 60 percent of the allowable charge for the service performed by the physician alone. Medical direction occurs if the physician medically directs qualified CRNAs in two, three or four concurrent cases and the physician performs the following activities that must be documented in the anesthesia record:
• Performs a pre-anesthetic examination and evaluation;
• Prescribes the anesthesia plan;
• Personally participates only in the most demanding procedures in the anesthesia plan, when clinically appropriate;
• Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
• Monitors the course of anesthesia administration at frequent intervals;
• Remains physically present and available in the operating room and/or recovery areas for immediate diagnosis and treatment of emergencies; and
• Provides indicated post-anesthesia care.
If the physician is involved with a single case with a CRNA, we will pay the physician service and the CRNA service in accordance with the medical direction payment policy outlined in these guidelines.
If anesthesiologists are in a group practice, one physician member may provide the pre-anesthesia examination and evaluation while another fulfills the other criteria. Similarly, one physician member of the group may provide post-anesthesia care while another member of the group furnishes the other component parts of the anesthesia service. The medical record must indicate that the services were furnished by physicians and identify the physician(s) who furnished them.
A physician who is concurrently directing the administration of anesthesia to not more than four surgical patients cannot ordinarily be involved in furnishing additional services to other patients. However, addressing an emergency of short duration in the immediate area, administering an epidural or caudal anesthetic to ease labor pain, or periodic, rather than continuous, monitoring of an obstetrical patient, does not substantially diminish the scope of control exercised by the physician in directing the administration of anesthesia to surgical patients. It does not constitute a separate service for the purpose of determining whether the medical direction criteria are met. Further, while directing concurrent anesthesia procedures, a physician may receive patients entering the operating suite for the next surgery, check or discharge patients in the recovery room, or handle scheduling matters without affecting fee schedule payment.
If the physician leaves the immediate area of the operating suite for other than short durations or devotes extensive time to an emergency case or is otherwise not available to respond to the immediate needs of the surgical patients, the physician’s services to the surgical patients are supervisory in nature and would not be considered medical direction.
Services involving administration of anesthesia should be reported by the use of the Current Procedural Terminology anesthesia five-digit procedure codes, American Society of Anesthesiologists (ASA) or Procedure surgical codes plus a modifier. HMO Blue Texas and Blue Cross and Blue Shield of Texas will require that the appropriate anesthesia modifier be filed on anesthesia services.
An anesthesiologist or a CRNA can provide anesthesia services. The anesthesiologist and the CRNA can bill separately for anesthesia services personally performed. When an anesthesiologist provides medical direction to a CRNA, both the anesthesiologist and the CRNA should bill for the appropriate component of the procedure performed. Each provider should use the appropriate anesthesia modifier.
In keeping with the American Medical Association Current Procedural Terminology Book, services involving administration of anesthesia include the usual pre-operative and post-operative visits, the anesthesia care during the procedure, the administration of fluids and/or blood and the usual monitoring services (e.g., ECG, temperature, blood pressure, oximetry, capnography and mass spectrometry). Intra-arterial, central venous, and Swan-Ganz catheter insertion are allowed separately.
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