by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 26th, 2016
These six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in the CPT codebook to distinguish among various levels of complexity of the anesthesia service provided.
Example: 00100-P1
Physical Status modifiers are represented by the initial letter ‘P’ followed by a single digit from 1 to 6 as defined in the following list:
P1: A normal healthy patient
- (NO time allotment for reimbursement)
- Healthy, non-smoking, no or minimal alcohol use
P2: A patient with mild systemic disease
- (NO time allotment for reimbursement)
- Mild diseases only without substantive functional limitations. Examples include (but not limited to): current smoker, social alcohol drinker, pregnancy, obesity (30 < BMI < 40), well-controlled DM/HTN, mild lung disease
P3: A patient with severe systemic disease
- (15 Min Time allotment for Reimbursement)
- Substantive functional limitations; One or more moderate to severe diseases. Examples include (but not limited to): poorly controlled DM or HTN, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol dependence or abuse, implanted pacemaker, moderate reduction of ejection fraction, ESRD undergoing regularly scheduled dialysis, premature infant PCA < 60 weeks, history (>3 months) of MI, CVA, TIA, or CAD/stents.
P4: A patient with severe systemic disease that is a constant threat to life
- (30 Min Time allotment for Reimbursement)
- Examples include (but not limited to): recent ( < 3 months) MI, CVA, TIA, or CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe reduction of ejection fraction, sepsis, DIC, ARD or ESRD not undergoing regularly scheduled dialysis
P5: A moribund patient who is not expected to survive without the operation
- (45 Min Time allotment for Reimbursement)
- Examples include (but not limited to): ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel in the face of significant cardiac pathology or multiple organ/system dysfunction
P6: A declared brain-dead patient whose organs are being removed for donor purposes
- (NO time allotment for reimbursement)
Appropriate Usage
- Append to anesthesia service/procedure codes
- The modifiers are informational only and do not affect payment
Inappropriate Usage
- Appending this modifier to CPT codes other than Anesthesia codes: 00100 through 01999
- Appending the modifier for a situation other than the one described by the descriptor
TIP: Medicare does not recognize Physical Status P modifiers.
References:
Quick, Current, Complete - www.findacode.com