1. Explain the 4 main classifications of anesthesia, and provide an example of each.
Anesthesia is a reversible, pharmacologically induced state of analgesia, loss of skeletal muscle reflexes and/or responsiveness, amnesia, decreased stress response. Depending on the type of anesthesia used, the aforementioned effects may occur as one or they may occur together simultaneously. Generally, there are four major classifications of anesthesia; local, regional, general anesthesia and moderate sedation (Brookside Associates, 2010).
General anesthesia (GA) depresses the central nervous system producing a reversible loss of consciousness and skeletal muscle reflexes and analgesia. Basically, general anesthesia has three phases; induction, maintenance and emergence phases. General anesthetic agents are administered either via intravenous or inhalational routes. Sodium thiopental and nitrous oxide are examples of intravenous and inhalational anesthetic agents respectively. General anesthesia can be used to provide anesthesia for any surgical procedure and on patients of any age. However, GA is associated with the risks of respiratory and circulatory depression. Of further note is that no single general anesthetic agent meets the criteria established for an ideal anesthetic agent. This necessitates the use of more than one anesthetic agent so as to produce optimal anesthetic effect while minimizing the side effects. For example, sodium thiopental is normally used for induction following which it is supplemented with an inhalational anesthetic during the maintenance phase. Thoracic, head and neck surgeries are examples of surgeries in which general anesthesia can be used (Brookside Associates, 2010).
Regional anesthesia otherwise referred to as regional block is produced by the injection of an anesthetic agent near a nerve or near a nerve pathway. It causes loss of sensation in the anaesthetized area which is normally a large region of the body but the patient remains awake. Sometimes, skeletal muscle reflexes in the anesthetized area are also lost. Regional anesthesia can be achieved via nerve, epidural or subdural blocks. Injection of a local anesthetic agent around a nerve trunk that supplies a specific area for example, the face or jaw produces a nerve block. Subdural blocks on the other hand are achieved by injecting an anesthetic agent into the cerebrospinal fluid though a lumber puncture. They provide spinal anesthesia by causing autonomic, motor and sensory blockage. They are mainly used for surgery involving the lower extremities, perineal areas and lower abdomen. Meanwhile epidural blocks are achieved by injecting the anesthetic agent into the epidural interspace via the lumbar interspace (Brookside Associates, 2010).
Local anesthesia refers to the direct administration of a local anesthetic agent into tissues either topically or via local infiltration. Local infiltration is employed when suturing small wounds or during minor surgical procedures like skin biopsies. Topical anesthetic agents on the other hand are used on mucous membranes, burns, wounds and open skin surfaces (Brookside Associates, 2010).
Moderate sedation otherwise called conscious sedation refers to the depression of consciousness which is drug induced whereby the patient retains the ability to respond purposefully to either verbal commands or verbal commands combined with tactile stimulation. It is used to minimize discomfort and alleviate anxiety in patients during procedures like endoscopy. The anesthetic agent in this case is administered intravenously (Centers for MEDICARE AND MEDICAID, 2010, p.9).
2. Research and explain the 4 different sets of modifiers used for billing anesthesia and provide an example of each.
Anesthesia modifiers are used together with anesthesia procedure codes. Their main purpose is to indicate whether the procedure was performed personally by an anesthesiologist or whether it was medically supervised, medically directed or monitored anesthesia care as shown in the examples below. For personally provided, the code AA is used when the anesthesia services were provided by the anesthesiologist or physician personally. As far as medically supervised anesthesia services are concerned, the code AD is used to indicate that the anesthesia services were medically supervised by a physician in which case the anesthesiologist was providing more than 4 concurrent anesthesia services at the same time and therefore had other qualified individuals assisting him/her.
Meanwhile the code QS under which codes G8 and G9 fall are used for monitored anesthesia care (MAC). G8 indicates (MAC) provided either by a physician or any qualified individual who receives medical direction from a physician during the procedure or the monitoring of the patients physiological vital signs in order to anticipate the need for general anesthesia or monitoring to detect the development of any adverse physiological reactions; this code does not affect reimbursement. G9 is also used to indicate monitored anesthesia care but in this case for an at risk patient, it’s also an informational modifier and hence does not affect reimbursement.
In regard to medically directed anesthetic services; the code QK is used when there is concurrent medical direction of two to four anesthesia procedures involving qualified personnel. Codes QY and QX are used in situations whereby anesthesia services are provided by a CRNA who is under the medical direction of a single physician and by CRNA under the medical direction of a physician respectively. QZ is used to indicate that anesthesia services were provided by a CRNA without the medical direction of a physician (Centers for MEDICARE AND MEDICAID, 2010, pp. 17-18).
3. Describe 2 different radiology procedures
Magnetic resonance imaging (MRI) refers to the radiology procedure in which there is an interaction between an external magnetic field, certain key atomic nuclei in the body and applied radiofrequency (RF) waves. MRI is traditionally used to clarify the findings of other radiography findings such as those of x-rays although it is rapidly being adopted as the primary modality in the evaluation of certain diseases. The strengths of MRI lie in its ability to provide high contrast of soft tissues, multiplanar imaging and last but not least that fact that it is non-invasive (Shields, p.167).
X-rays refers to electromagnetic radiation whose wavelengths range from 0.01 to 10 nanometers. X-ray machines normally found in a hospital radiology department send x-ray particles through the body with the images being recorded on special films or on computers. Dense structures in the body like bones and contrast media block majority of the x-ray particles and hence appear white. Air containing structures on the other hand appear black whilst fat, muscle and fluids have a greyish appearance (Shields, p.167).
Brookside Associates (2007). Nursing fundamentals II multimedia edition: The intraoperative
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Centers for MEDICARE and MEDICAID SERVICES (2010). Anesthesia billing guide.
Shields, T.W., Reed, C.E., LoCicero, J. & Feins, R.H. (2009). General thoracic surgery.
Philadelphia, PA: Lippincott Williams and Wilkins & Wolters Kluwer Business.