Saturday, April 22, 2017

Monitored anesthesia cpt code list


CPT/HCPCS Codes

Group 1 Paragraph: These CPT codes are the Anesthesia and Moderate Sedation codes addressed for coverage in this LCD:

Modifiers used:
QS Monitored anesthesia care (MAC)
G8 Monitored anesthesia care (MAC) for deep, complex, complicated, or markedly invasive surgical procedure
G9 Monitored anesthesia care (MAC) for patient who has history of severe cardio-pulmonary condition

Use G8 modifier for the following CPT codes for MAC:
00100
00160
00300
00400
00532
00920


Group 1 Codes:

00100 ANESTHESIA FOR PROCEDURES ON SALIVARY GLANDS, INCLUDING BIOPSY

00124 ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, AND INNER EAR INCLUDING BIOPSY; OTOSCOPY

00148 ANESTHESIA FOR PROCEDURES ON EYE; OPHTHALMOSCOPY

00160 ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; NOT OTHERWISE SPECIFIED

00164 ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; BIOPSY, SOFT TISSUE

00300 ANESTHESIA FOR ALL PROCEDURES ON THE INTEGUMENTARY SYSTEM, MUSCLES AND NERVES OF HEAD, NECK, AND POSTERIOR TRUNK, NOT OTHERWISE SPECIFIED

00400 ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES, ANTERIOR TRUNK AND PERINEUM; NOT OTHERWISE SPECIFIED

00410 ANESTHESIA FOR PROCEDURES ON THE INTEGUMENTARY SYSTEM ON THE EXTREMITIES, ANTERIOR TRUNK AND PERINEUM; ELECTRICAL CONVERSION OF ARRHYTHMIAS

00520 ANESTHESIA FOR CLOSED CHEST PROCEDURES; (INCLUDING BRONCHOSCOPY) NOT OTHERWISE SPECIFIED

00522 ANESTHESIA FOR CLOSED CHEST PROCEDURES; NEEDLE BIOPSY OF PLEURA

00524 ANESTHESIA FOR CLOSED CHEST PROCEDURES; PNEUMOCENTESIS

00530 ANESTHESIA FOR PERMANENT TRANSVENOUS PACEMAKER INSERTION

00532 ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION

00702 ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; PERCUTANEOUS LIVER BIOPSY

00740 ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODENUM

00810 ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM

00920 ANESTHESIA FOR PROCEDURES ON MALE GENITALIA (INCLUDING OPEN URETHRAL PROCEDURES); NOT OTHERWISE SPECIFIED

01420 ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR REPAIR INVOLVING KNEE JOINT

01730 ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERUS AND ELBOW

01780 ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; NOT OTHERWISE SPECIFIED

01916 ANESTHESIA FOR DIAGNOSTIC ARTERIOGRAPHY/VENOGRAPHY

01920 ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING CORONARY ANGIOGRAPHY AND VENTRICULOGRAPHY (NOT TO INCLUDE SWAN-GANZ CATHETER)

01922 ANESTHESIA FOR NON-INVASIVE IMAGING OR RADIATION THERAPY

01935 ANESTHESIA FOR PERCUTANEOUS IMAGE GUIDED PROCEDURES ON THE SPINE AND SPINAL CORD; DIAGNOSTIC

01936 ANESTHESIA FOR PERCUTANEOUS IMAGE GUIDED PROCEDURES ON THE SPINE AND SPINAL CORD; THERAPEUTIC

01999 UNLISTED ANESTHESIA PROCEDURE(S)

99151 MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO ASSIST IN THE MONITORING OF THE PATIENT'S LEVEL OF CONSCIOUSNESS AND PHYSIOLOGICAL STATUS; INITIAL 15 MINUTES OF INTRASERVICE TIME, PATIENT YOUNGER THAN 5 YEARS OF AGE

99152 MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO ASSIST IN THE MONITORING OF THE PATIENT'S LEVEL OF CONSCIOUSNESS AND PHYSIOLOGICAL STATUS; INITIAL 15 MINUTES OF INTRASERVICE TIME, PATIENT AGE 5 YEARS OR OLDER

99153 MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO ASSIST IN THE MONITORING OF THE PATIENT'S LEVEL OF CONSCIOUSNESS AND PHYSIOLOGICAL STATUS; EACH ADDITIONAL 15 MINUTES INTRASERVICE TIME (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE)

99155 MODERATE SEDATION SERVICES PROVIDED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL OTHER THAN THE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS; INITIAL 15 MINUTES OF INTRASERVICE TIME, PATIENT YOUNGER THAN 5 YEARS OF AGE

99156 MODERATE SEDATION SERVICES PROVIDED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL OTHER THAN THE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS; INITIAL 15 MINUTES OF INTRASERVICE TIME, PATIENT AGE 5 YEARS OR OLDER

99157 MODERATE SEDATION SERVICES PROVIDED BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL OTHER THAN THE PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTIC SERVICE THAT THE SEDATION SUPPORTS; EACH ADDITIONAL 15 MINUTES INTRASERVICE TIME (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY SERVICE)

G0500 MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING A GASTROINTESTINAL ENDOSCOPIC SERVICE THAT SEDATION SUPPORTS, REQUIRING THE PRESENCE OF AN INDEPENDENT TRAINED OBSERVER TO ASSIST IN THE MONITORING OF THE PATIENT'S LEVEL OF CONSCIOUSNESS AND PHYSIOLOGICAL STATUS; INITIAL 15 MINUTES OF INTRA-SERVICE TIME; PATIENT AGE 5 YEARS OR OLDER (ADDITIONAL TIME MAY BE REPORTED WITH 99153, AS APPROPRIATE)



Coverage Indications, Limitations, and/or Medical Necessity

Monitored Anesthesia Care

With advances in modern medical technology, there has been a shift in supplying some surgical and diagnostic services to an ambulatory, outpatient or office setting. Accompanying this, there has been a change in the provision of anesthesia services from the traditional general anesthetic to a combination of local, regional and certain mind-altering drugs. This type of anesthesia is referred to as monitored anesthesia care (MAC) if directly provided by anesthesia personnel. MAC requires careful and continuous evaluation of various vital physiologic functions and the diagnosis and treatment of any deviations. This type of anesthesia can be provided by a variety of qualified anesthesia personnel.

Coverage for MAC is allowed if the anesthesia service is medically reasonable and necessary and if the procedure for which MAC is given is itself a Medicare benefit and is medically reasonable and necessary.

1. In keeping with the American Society of Anesthesiologists' standards for monitoring, MAC should be provided by qualified anesthesia personnel, (anesthesiologists or qualified anesthetists such as certified registered nurse anesthetists or anesthesia assistants). These individuals must be continuously present to monitor the patient and provide anesthesia care.

2. During MAC, the patient's oxygenation, ventilation, circulation and temperature should be evaluated by whatever method is deemed most suitable by the attending anesthetist. Close monitoring is necessary to anticipate the need for general anesthesia administration or for the treatment of adverse physiologic reactions such as hypotension, excessive pain, difficulty breathing, arrhythmias, adverse drug reactions, etc. In addition, the possibility that the surgical procedure may become more extensive, and/or result in unforeseen complications, requires comprehensive monitoring and/or anesthetic intervention.

3. The following CMS requirements for this type of anesthesia should be the same as for general anesthesia with regards to the performance of pre-anesthetic examination and evaluation, prescription of the anesthesia care required, the completion of an anesthesia record, the administration of necessary oral or parenteral medications and the provision of indicated post-operative anesthesia care. Appropriate documentation must be available to reflect pre and post-anesthetic evaluations and intraoperative monitoring.

4. The MAC service rendered must be appropriate and medically reasonable and necessary.

5. Anesthesia procedures listed in the CPT/HCPCS section are usually provided by the attending surgeon and are included in the global fee and are not separately billable. In certain instances, however, MAC provided by anesthesia personnel may be necessary for these procedures. This is true if there are one or more of the co-existing conditions present that are listed below under the ICD-10-CM code list. In this situation, the appropriate MAC modifier is QS, which should be billed along with the appropriate ICD-10-CM Code for the co-existing condition(s). Second the MAC modifier G8 can be used with the anesthesia services listed below and indicates that the surgical procedure is deep, complex, complicated or markedly invasive. These services include only procedures on the face (00100 and 00160); head, neck, and posterior trunk (00300); breast (00400), or genitalia (00920) and for access to the central venous circulation (00532). These CPT codes themselves do not differentiate complexity. The MAC modifier G9 is used with an anesthesia code to indicate that the patient has a history of a severe cardiopulmonary condition.

In summary, MAC may be necessary and justified for the CPT/HCPCS procedures with the QS modifier if a co-existing condition exists, or if the procedure qualifies for a G8 modifier.

6. Reimbursement for MAC will be the same amount allowed for full general anesthesia services if all the requirements listed under these indications are met. No additional reimbursement is allowed with the use of modifiers (e.g., G8, G9). The provision of quality MAC is mandatory and requires the same expertise and the same effort (work) as required in the delivery of a general anesthetic. If the requirements are not fulfilled or the procedures are unnecessary, payment will be denied in full.

7. The presence of an underlying condition alone, as reported by an ICD-10-CM code, may not be sufficient evidence that MAC is necessary. The medical condition must be significant enough to impact the need to provide MAC, such as the patient being on medication or being symptomatic, etc. The presence of a stable, treated condition of itself is not necessarily sufficient.

The following quote is from Guidelines for the use of deep sedation and anesthesia for GI endoscopy, Gastrointestinal Endoscopy, Volume 56, No. 5, 2002, p. 616. "The routine assistance of an anesthesiologist for average risk patients undergoing standard upper and lower endoscopic procedures is not warranted and is cost prohibitive." This position of the gastrointestinal endoscopy community justifies this LMRP/LCD's position that, to allow payment, MAC for these procedures must be justified by the presence of one of the listed conditions.

Moderate (Conscious) Sedation

Anesthesia services range in complexity. The continuum of anesthesia services, from least intense to most intense in complexity is as follows: local or topical anesthesia, moderate (conscious) sedation, regional anesthesia and general anesthesia. Prior to 2006, Medicare did not recognize separate payment if the same physician provided the medical or surgical procedure and the anesthesia needed for the procedure.

Moderate sedation is a drug induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Moderate sedation does not include minimal sedation, deep sedation or monitored anesthesia care. In 2017, the CPT added new codes 99151-99153, 99155-99157 and G0500 for moderate or conscious sedation.

CPT codes 99151 to 99153 describe moderate sedation provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status. Appendix G has been removed. The value related to moderate sedation has been removed from the codes previously listed in Appendix G. CPT codes 99155 to 99157 describe moderate sedation provided by a physician other than the health care professional performing the diagnostic or therapeutic service that the sedation supports. G0500 describes moderate sedation by the same practitioner when that practitioner is performing an endoscopy service (the pertinent codes are 43200 through 45398, G0105 and G0121).

If the anesthesiologist or CRNA provides anesthesia for diagnostic or therapeutic nerve blocks or injections and a different provider performs the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using CPT code 01991. The service must meet the criteria for monitored anesthesia care. If the anesthesiologist or CRNA provides both the anesthesia service and the block or injection, then the anesthesiologist or CRNA may report the anesthesia service using the conscious sedation code and the injection or block. However, the anesthesia service must meet the requirements for conscious sedation and if a lower level complexity anesthesia service is provided, then the conscious sedation code should not be reported.

If the physician performing the medical or surgical procedure also provides a level of anesthesia lower in intensity than moderate or conscious sedation, such as a local or topical anesthesia, then the conscious sedation code should not be reported and no payment should be allowed by the carrier. There is no CPT code for the performance of local anesthesia and as payment for this service is considered in the payment for the underlying medical or surgical service.

Medicare will cover the codes 99151–99153, 99155-99157 and G0500 under the following conditions:

1. Moderate Sedation should be provided by a qualified physician (as defined by Medicare and within the scope of practice of the state). The physician must be continuously present to monitor the patient and personally provide care.

2. During Moderate Sedation, the patient's oxygenation, ventilation, circulation and temperature should be evaluated by whatever method is deemed most suitable by the attending physician. Close monitoring is necessary to anticipate the need for general anesthesia administration or for the treatment of adverse physiologic reactions such as hypotension, excessive pain, difficulty breathing, arrhythmias, adverse drug reactions, etc. In addition, the possibility that the surgical procedure may become more extensive, and/or result in unforeseen complications, requires comprehensive monitoring and/or anesthetic intervention.

3. The following CMS requirements for Moderate Sedation should be the same as for MAC and general anesthesia with regards to the performance of pre-sedation examination and evaluation, prescription of the sedation care required, the completion of a record, the administration of necessary oral or parenteral medications and the provision of indicated post-operative care. Appropriate documentation must be available to reflect pre and post-sedation evaluations and intraoperative monitoring.

4. The Moderate Sedation service rendered must be appropriate and medically reasonable and necessary.

5. The presence of an underlying condition alone, as reported by an ICD-10-CM code, may not be sufficient evidence that Moderate Sedation is necessary. The medical condition must be significant enough to impact the need to provide Moderate Sedation. The presence of a stable, treated condition of itself is not necessarily sufficient.

6. The above conditions of coverage must be met, however, diagnostic criteria as listed in this LCD will not be applied to Moderate Sedation services.

Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review.




ICD-10 Codes that Support Medical Necessity



ICD-10 CODE DESCRIPTION

A18.84 Tuberculosis of heart
A37.01 Whooping cough due to Bordetella pertussis with pneumonia
A37.11 Whooping cough due to Bordetella parapertussis with pneumonia
A37.81 Whooping cough due to other Bordetella species with pneumonia
A37.91 Whooping cough, unspecified species with pneumonia
A40.3* Sepsis due to Streptococcus pneumoniae
A48.1 Legionnaires' disease
B25.0 Cytomegaloviral pneumonitis
B44.81 Allergic bronchopulmonary aspergillosis
D65 Disseminated intravascular coagulation [defibrination syndrome]
D66 Hereditary factor VIII deficiency
D67 Hereditary factor IX deficiency
D68.0 Von Willebrand's disease
D68.1 Hereditary factor XI deficiency
D68.2 Hereditary deficiency of other clotting factors
D68.311 Acquired hemophilia
D68.312 Antiphospholipid antibody with hemorrhagic disorder
D68.318 Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors
D68.32 Hemorrhagic disorder due to extrinsic circulating anticoagulants
D68.4 Acquired coagulation factor deficiency
D68.8 Other specified coagulation defects
D68.9 Coagulation defect, unspecified
E00.0 Congenital iodine-deficiency syndrome, neurological type
E00.1 Congenital iodine-deficiency syndrome, myxedematous type
E00.2 Congenital iodine-deficiency syndrome, mixed type
E00.9 Congenital iodine-deficiency syndrome, unspecified
E01.8 Other iodine-deficiency related thyroid disorders and allied conditions
E02 Subclinical iodine-deficiency hypothyroidism
E03.0 Congenital hypothyroidism with diffuse goiter
E03.1 Congenital hypothyroidism without goiter
E03.2 Hypothyroidism due to medicaments and other exogenous substances
E03.3 Postinfectious hypothyroidism
E03.8 Other specified hypothyroidism
E03.9 Hypothyroidism, unspecified
E05.00 Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm
E05.01 Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm
E05.10 Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm
E05.11 Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm
E05.20 Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm
E05.21 Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm
E05.30 Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm
E05.31 Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm
E05.40 Thyrotoxicosis factitia without thyrotoxic crisis or storm
E05.41 Thyrotoxicosis factitia with thyrotoxic crisis or storm
E05.80 Other thyrotoxicosis without thyrotoxic crisis or storm
E05.81 Other thyrotoxicosis with thyrotoxic crisis or storm
E05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or storm
E05.91 Thyrotoxicosis, unspecified with thyrotoxic crisis or storm
E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma
E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma
E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy
E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema
E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema
E08.36 Diabetes mellitus due to underlying condition with diabetic cataract
E08.39 Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication
E08.65 Diabetes mellitus due to underlying condition with hyperglycemia
E08.69 Diabetes mellitus due to underlying condition with other specified complication
E08.8 Diabetes mellitus due to underlying condition with unspecified complications
E09.01 Drug or chemical induced diabetes mellitus with hyperosmolarity with coma
E09.11 Drug or chemical induced diabetes mellitus with ketoacidosis with coma
E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy
E09.311 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema
E09.319 Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema
E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract
E09.39 Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication
E09.65 Drug or chemical induced diabetes mellitus with hyperglycemia
E09.69 Drug or chemical induced diabetes mellitus with other specified complication
E09.8 Drug or chemical induced diabetes mellitus with unspecified complications
E10.10 Type 1 diabetes mellitus with ketoacidosis without coma
E10.11 Type 1 diabetes mellitus with ketoacidosis with coma
E10.21 Type 1 diabetes mellitus with diabetic nephropathy
E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.36 Type 1 diabetes mellitus with diabetic cataract
E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified
E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.65 Type 1 diabetes mellitus with hyperglycemia
E10.69 Type 1 diabetes mellitus with other specified complication
E10.8 Type 1 diabetes mellitus with unspecified complications
E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)
E11.21 Type 2 diabetes mellitus with diabetic nephropathy
E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.65 Type 2 diabetes mellitus with hyperglycemia
E11.69 Type 2 diabetes mellitus with other specified complication
E11.8 Type 2 diabetes mellitus with unspecified complications
E15 Nondiabetic hypoglycemic coma
E16.0 Drug-induced hypoglycemia without coma
E16.1 Other hypoglycemia
E16.3 Increased secretion of glucagon
E16.4 Increased secretion of gastrin
E16.8 Other specified disorders of pancreatic internal secretion
E16.9 Disorder of pancreatic internal secretion, unspecified
E20.0 Idiopathic hypoparathyroidism
E20.8 Other hypoparathyroidism
E20.9 Hypoparathyroidism, unspecified
E21.0 Primary hyperparathyroidism
E21.1 Secondary hyperparathyroidism, not elsewhere classified
Group 1 Medical Necessity ICD-10 Codes Asterisk Explanation: * A40.1 - A41.9 Acute sepsis supported by diagnosis
* E05.00 - E89.00-Severe metabolic disorders
* E86.0-E87.8 Electrolyte imbalance supported by sodium, potassium or calcium levels, etc, outside normal limits
* E66.01 Two times ideal body weight
* F01.50-F25.8 Brain syndrome/dementia with confusion or combative behavior and various type psychoses (supported by diagnosis)
* F41.0-F41.8 Supported by diagnosis, type and need for and response to sedative medication
* F11.20-F19.288 Acute detoxification state
* F10.10-F10.129 Acute drunkenness
* F12.10-F12.90 Acute detoxification state
* F16.10–F16.90 Acute detoxification state
* F13.10–F13.90 Acute detoxification state
* F11.10–F11.90 Acute detoxification state
* F14.10–F14.90 Acute detoxification state
* F15.10–F15.90 Acute detoxification state
* F19.10–F19.90 Acute detoxification state
* I10 Unstable (systolic pressure over 180, or diastolic over 110 and on more than two anti-hypertensive medications)
* I11.0–I11.9 Acute, multiple medications, etc.
* I60.01-I167.841 Acute condition supported by diagnosis and treatment
* K70.11-K76.89 Hepatic failure (bilirubin greater than 3)
* K92.2) Massive gastrointestinal bleeding (over 500 cc blood loss by history as an example)
* Z93.0 Supported by history, diagnosis
* Z79.891 Use of high-risk medication when that medication may affect the choice of anesthesia

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