Anesthesia CPT (Primary)

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Description

This phenotype is used to determine the single primary anesthesia Current Procedural Terminology (CPT) billing code for each case. This phenotype also returns the MPOG anesthesia CPT class and the MPOG base unit.

Limitation

Any combined cases are returned as a single CPT code. An example is in OB, an epidural case that emergently goes to the OR for a C/S, if not listed as a separate case will return only a single anesthesia CPT code. Uploaded unit values are freely entered by presenting site and are unbounded. Thus, they may contain errors in documentation that fall outside acceptable base unit value ranges.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Categorical

Enumeration

Value	Value Code	Definition

Return Columns

Column Name	Data Type

Granularity

Logic

Step 1: Determine Primary Anesthesia CPT Code

Search for any anesthesia procedure codes linked to the case. Consider all codes marked as anesthesia codes, as well as any codes starting with 00 or 01 that are marked as surgical codes
1. If a single code is found, that one is returned as the primary anesthesia code
2. If multiple codes are found, they are ranked using the following criteria and the highest ranked code is returned as the primary code:
  1. The procedure code priority (if available)
  2. Total anesthesia time units (if unavailable, use the base time units from the CPT catalog)
  3. Codes defined as secondary are ranked below other codes
  4. As a final tiebreaker, the CPT codesa re ranked alphabetically
3. If a case has no documented anesthesia procedure codes, search for surgical procedure codes linked to the case. Those surgical codes are then matched to the typical anesthesia code for that procedure, as listed in the ASA CPT crosswalk
  1. If a single code is found, that one is returned as the primary anesthesia code
  2. If multiple anesthesia codes arise from the cross-walking, they ar ranked using the following criteria. The highest ranked code is returned as the primary code:
    1. The original surgical code's procedure priority (if available)
    2. Radiology procedures are ranked below non-radiology procedures (given thy have atypically high base time unit)
    3. The anesthesia codes' base time units from the CPT catalog
    4. Codes defined as secondary are ranked below other codes
    5. As a final tiebreaker, the CPT codes are ranked alphabetically
If there is not a CPT uploaded, then the case is omitted from the collation, return NULL

Step 2: Specify the CPT into a class that is assigned by CPT groupings below

Anesthesia CPT Classes (as of 2/13/18)

Area of the Body	CPT Code Range
Head	00100-00222
Neck	00300-00352
Thorax (chest wall and shoulder girdle)	00400-00474
Intrathoracic	00500-00580
Spine and Spinal Cord	00600-00670
Upper Abdomen	00700-00797
Lower Abdomen	00800-00882
Perineum	00902-00952
Pelvis (except hip)	0112-01190
Upper Leg (except knee)	01200-1274
Knee and Popliteal Area	01320-01444
Lower Leg (below knee, including ankle and foot)	01462-01522
Shoulder and Axilla	01610-01682
Upper Arm and Elbow	01710-01782
Forearm, Wrist and Hand	01810-01860
Radiological Procedure	01916-01936
Burn Excisions or Debridement	01951-01953
Obstetric	01958-01969
Other Procedure	01990-01999