AAPC Certified Professional Coder (CPC) — All Questions
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How is the payment for an anesthesia service calculated?
- a.(Base units + time units + modifying units) multiplied by a locality conversion factor✓
- b.A single flat fee per anesthesia case regardless of duration
- c.Work RVU multiplied by the geographic practice cost index only
- d.A percentage of the surgeon's fee for the procedure
Anesthesia uses base units (assigned to each anesthesia CPT code by procedure complexity) plus time units (typically each 15 minutes) plus any modifying units (physical status P3-P5, qualifying circumstances), all multiplied by an anesthesia conversion factor. This unit-and-time model is unique to anesthesia and differs from the RVU method used for most other services.
The anesthesia physical status modifier P3 describes which patient?
- a.A normal, healthy patient
- b.A patient with mild systemic disease
- c.A patient with severe systemic disease✓
- d.A moribund patient not expected to survive without the operation
Physical status modifiers P1-P6 grade the patient's condition: P1 normal healthy, P2 mild systemic disease, P3 severe systemic disease, P4 severe systemic disease that is a constant threat to life, P5 moribund, P6 brain-dead organ donor. P3, P4, and P5 typically add modifying units because they reflect increased anesthesia risk and complexity.
Which situation is reported with an anesthesia qualifying circumstances add-on code?
- a.Routine anesthesia for a healthy adult elective procedure
- b.Anesthesia complicated by extreme age (younger than 1 year or older than 70)✓
- c.Standard monitored anesthesia care for a screening endoscopy
- d.Local anesthesia administered by the operating surgeon
Qualifying circumstances describe conditions that significantly raise anesthesia complexity — extreme age, use of total body hypothermia or controlled hypotension, and emergency conditions. They are add-on codes reported in addition to the primary anesthesia code. Routine cases and surgeon-administered local anesthesia do not qualify.