Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

Use Examples to Assign ASA Physical Status

Surgeons operating on patient in an operating theatre

For anesthesiologists, assigning the physical status of the patient is an important indicator for patient care as well as for correct coding and billing. The six levels of physical status as outlined by the American Society of Anesthesiologists (ASA) allow physicians to acknowledge and communicate to other clinicians and, later, payers, the extra precautions needed to treat patients during surgery. In some cases, determining physical status correctly makes the difference in whether or not the procedure can even continue as planned.

However, a recent study conducted by The University of Texas Medical Branch at Galveston found that choosing the physical status based on each level’s definition alone results in a lot of variation and subjectivity among anesthesiologists that could place the patient at risk or cause an incorrect claim to be submitted to payers.

Here’s what researchers found.

According to a recent Anesthesiology News article, in the study, physicians were given descriptions of patients and first asked to determine their physical status using only the definitions of each level. On a second pass, physicians were given examples for each level—the examples that the ASA added to their physical status classifications back in October 2014. Using the definition only, about half of the physicians chose the “correct” physical status. Adding the examples, the same physicians were able to choose the correct status 8 out of 10 times.

Of course, even “correct” can be somewhat subjective, because clinicians might disagree on the definition of words like “moderate” or “severe.” That was one criticism of UT’s research. “A weakness of the study is that no final authority exists to determine physical status [PS], so comparisons with a ‘correct’ value are suspect, especially in gray areas,” said Robert E. Johnstone, MD, professor of anesthesiology at West Virginia University in Morgantown.

But even if “correct” is hard to determine, the results do show that physicians were able to more consistently assign physical status levels, and Johnstone says, “the more consistency … the better, because work assignments, quality assessments and finances are affected.”

The takeaway from this study is simple.

First, anesthesiologists and other surgical suite clinicians should familiarize themselves with the ASA examples of physical status levels in order to more consistently (and more correctly, some think) assign physical status. The examples are included annually in the ASA Relative Value Guide and are listed below for your convenience.

Second, anesthesia billing companies and departments should also become more famiilar with payment policies for physical status. For instance, Medicare does not reimburse based on physical status. However, some payers do, including Indiana Medicaid. As well, some services are covered by payers dependent on the physical status of patients, like Anthem’s policy to cover monitored anesthesia care during surgical procedures for patients with higher physical status levels when it would otherwise be unnecessary.

Physical Status Definition Examples, including, but not limited to:
P1 A normal healthy patient Healthy, non-smoking, no or minimal alcohol use
P2 A patient with mild systemic disease 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 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 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 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

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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