CPT Coding Essentials for

Anesthesiology and Pain Management

2019 1st Edition ■ Ebook PDF Version
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 CODING ESSENTIALS

Anesthesia and
Pain Management 2019

INCLUDES CPT TO ICD CROSSWALKS

CPT® Coding Essentials for Anesthesia and Pain Management 2019 Codes List

Ancillary Codes 80361 95860-95864

71045-71048 80362-80364 95866
72020 80365 95867-95868
72040-72052 80366 95869
72070-72074 80368 95870
72080 80369-80370 95872
72081-72084 80372 95873
72100-72114 80373 95874
72120 82286 95905
72125-72127 82310 95907-95913
72128-72130 82330 95921-95922
72131-72133 82374 95923
72141-72142 82435 95925-95927
72146-72147 82947-82948 95928-95929
72148-72149 83873 95970-95972
72156-72158 84132 95990-95991
72200-72202 84260 96150-96151
72240-72270 84295 96152-96155
72275 85002 96360-96361
72285 85004 96365-96368
72295 85013-85014 96369-96371
75901 85018 96372
75902 85025-85027 96373
76800 85041 96374-96376
76942 85045-85046 97810-97814
77001 85048 99000-99001
77002 85049 99024
77003 85345 99026-99027
77021 85610-85611 99050
80047-80048 85651-85652 99051
80050 90791-90792 99053
80051 90832-90838 99056
80053 90863 99058-99060
80171 90865 99070
80175 90867-90869 99071
80177 90870 99100
80199 90875-90876 99116
80203 90880 99135
80305-80307 90882 99140
80323 90885 99151-99153
80329-80331 90887 99155-99157
80332-80334 90889 99605-99607
80335-80337 90901 0106T-0110T
80338 92960-92961 0213T-0215T
80345 93000-93010 0216T-0218T
80346-80347 93040-93042 0228T-0229T
80348 93318 0230T-0231T
80349 94002-94004 0278T
80353 94760-94762 0440T-0442T
80354 95812-95813
80355 95831-95834
80357 95851-95852
80358 95857

3
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Introduction
Unlike other specialty coding books on the market, CPT® Coding
Essentials for Anesthesia and Pain Management 2019 combines
anesthesia and pain management-specific procedural coding
and reimbursement information with verbatim guidelines
and parenthetical information from the Current Procedural
Terminology (CPT®) codebook. Additionally, CPT® Coding
Essentials for Anesthesia and Pain Management 2019 enhances that
CPT-specific information by displaying pertinent diagnostic codes,
procedural descriptions, illustrations, relative value units (RVUs),
and more on the same page as the CPT code being explained. This
one book provides anesthesia and pain management coding and
billing knowledge that otherwise might take years of experience
or multiple resources to accumulate. It sets a foundation for
anesthesia and pain management coders and subspecialty coding
experts that facilitates correct code assignment.
This book includes reporting rules for CPT code submission as
written and enforced by the Centers for Medicare and Medicaid
Services (CMS). CPT® Coding Essentials for Anesthesia and Pain
Management 2019 is not intended to equip coders with infor-
mation to make medical decisions or to determine diagnoses or
treatments; rather, it is intended to aid correct code selection that
is supported by physician or other qualified health care profes-
sional (QHCP) documentation. This reference work does not
replace the need for a CPT codebook.
About the CPT® Coding Essentials
Editorial Team and Content Selection
The CPT® Coding Essentials series is developed by a team of vet-
eran clinical technical editors and certified medical coders. When
developing the content of this book, the team members consider
all annual new, revised, and deleted medical codes. They adhere
to authoritative medical research; medical policies; and official
guidelines, conventions; and rules to determine the final con-
tent presented within this book. Additionally, the team monitors
utilization and denial trends when selecting the codes highlighted
in CPT® Coding Essentials for Anesthesia and Pain Management
2019.
The main section of CPT® Essentials for Anesthesia and Pain
Management 2019 is titled “CPT® Procedural Coding.” This section
is organized for ease of use and simple lookup by displaying CPT
codes in numeric order. Each code-detail page of this section presents
a single code or multiple codes representing a code family concept.
The procedures featured in the CPT® Coding Essentials for Anesthesia
and Pain Management 2019 are those commonly performed by an
anesthesiologist or pain management specialist, but more difficult
to understand or miscoded in claims reporting. This book does
not provide a comprehensive list of all services performed in the
 5
specialty, nor all sites within impacted body systems. Similarly, the
CPT to ICD-10-CM crosswalks are intended to illustrate those
conditions that would most commonly present relative to the
procedure and the specialist. The crosswalks are not designed to
be an exhaustive list of all possible conditions for each procedure,
nor medical necessity reasons for coverage.
The “CPT Procedural Coding” section is complemented by
other sections that review anesthesia and pain management ter-
minology and anatomy, ICD-10-CM conventions and coding,
ICD-10-CM documentation tips, and ICD-10 procedure coding
system (ICD-10-PCS) coding and format. The appendices contain
data from the CMS National Correct Coding Initiative, multiple
ICD-10-CM compliant anesthesia and pain management condi-
tion documentation checklists, and evaluation and management
(E/M) documentation guidelines.
Sections Contained Within This Book
What follows is a section-by-section explanation of CPT® Coding
Essentials for Anesthesia and Pain Management 2019.
Terminology, Abbreviations, and Basic Anatomy
This section provides a quick reference tool for coders who may
come across unfamiliar terminology in medical record documen-
tation. This review of basic terminology displays lists of alphabet-
ized Greek and Latin root words, prefixes, and suffixes associated
with anesthesia and pain management.
The combination of root words with prefixes and suffixes is the
basis of medical terminology and enables readers to deduce the
meaning of new words by understanding the components. For
example, neuro is a root word for nerve, and –algia is a suffix for
pain; thus, neuralgia describes nerve pain.
Also included in this section are a glossary of anesthesia and pain
management-specific terms and a list of anesthesia and pain man-
agement acronyms and abbreviations. Keep in mind that these
glossary definitions are anesthesia and pain management-specific.
The same word may have a different meaning in a different spe-
cialty. In some cases, a parenthetical phrase after the anesthesia
and pain management term may provide the reader with a com-
mon acronym or synonym for that term. Pay particular atten-
tion to the use of capitalization in the abbreviation and acronym
list, as the same letters sometimes have varied meaning in clinical
nomenclature, depending on capitalization.
Introduction to ICD-10-CM and ICD-10-PCS
For coders who want a review, CPT® Coding Essentials for
Anesthesia and Pain Management 2019 recaps the development
of the ICD-10-CM and ICD-10-PCS code sets and outlines
important concepts pertaining to the ICD-10-CM code set.
Introduction
Lists of common diagnoses and conditions from the ICD-10-CM
code sets for each selected CPT code or code range may be found
within the “CPT Procedural Coding” section.
The ICD-10-CM content provided within this book complements
your use of the ICD-10-CM 2019 codebook. This section provides
a chapter-by-chapter overview of ICD-10-CM that includes com-
mon new diagnoses and their codes, as well as identification of new
or substantially changed chapter-specific guidelines for 2019.
ICD-10-PCS was commissioned by CMS and developed by
3M Health Information Systems for inpatient reporting of pro-
cedures to replace ICD-9-CM Volume 3. ICD-10-PCS is not
used for reporting physician services; however, an understand-
ing of ICD-10-PCS is essential to physician practices because
physician inpatient surgical documentation is used by hospitals
for the abstraction of ICD-10-PCS codes for hospital billing.
The nomenclature and structure of ICD-10-PCS diverges sig-
nificantly from ICD-9-CM Volume 3 and from CPT codes. An
overview of this structure is reviewed in this section.
ICD-10-CM Anatomy and Physiology
Advanced understanding of the nervous system, anatomy and
pathophysiology is essential to accurate coding for anesthesia and
pain management. A detailed study of the anatomy and physiol-
ogy of anesthesia and pain management gives beginner or inter-
mediate anesthesia and pain management coders the information
boost they may need to accurately abstract the medical record.
Neuron
Schwann
cell Myelin
sheath
Axon
Dendrite
Axon hillock
Axon
terminals
Membrane
Microtubules Nucleus
Nucleolus
The anatomy and physiology explanations are accompanied by
labeled and detailed illustrations for anesthesia and pain manage-
ment, beginning at the cellular level and extending to the func-
tions and interactions of the various body parts. This section also
includes discussion of common disorders of the nervous system
and other anatomical systems affected by anesthesia, their patho-
physiology, as well as coding exercises to assess mastery of the
anesthesia and pain management coding topic.
ICD-10-CM Documentation
Accurate, complete coding of diseases, disorders, injuries, condi-
tions, and even signs and symptoms using ICD-10-CM codes
requires extensive patient encounter documentation. This sec-
tion highlights commonly encountered anesthesia and pain
6
CPT® Coding Essentials for Anesthesia and Pain Management 2019
management conditions that require a high level of specificity for
documentation and reporting.
The documentation information is presented in an easy-to-­
understand bulleted format that enables the physician, QHCP,
and/or coder to quickly identify the specificity of documentation
required for accurate ICD-10-CM code abstraction. This section
also includes coding exercises to assess mastery of the anesthesia
and pain management documentation topic.
CPT® Procedural Coding
“CPT Procedural Coding” is the main section of this book and
displays pertinent coding and reimbursement data for each tar-
geted CPT code or code family on code-detail pages. The follow-
ing is presented within each surgical code detail page:
• CPT code and verbatim description with icons (when
required)
• Parentheticals (when they exist)
• Official AMA Coding Guidelines
• Plain English descriptions
• Illustrations
• ICD-10-CM diagnostic codes
• AMA CPT® Assistant newsletter references
• CMS Pub 100 references
• CMS base units or relative value units
• CMS global periods
• CMS modifier edits
Category III codes and codes from diagnostic chapters will con-
tain a truncated version of the code-detail page content, as diag-
nostic tests are too broad for all data elements contained in the
code-detail pages.
AMA Coding Guidelines
The guidelines and parenthetical instructions included in the
CPT codebook provide coders with insight into how the AMA
CPT Editorial Panel and CPT Advisory Committee intend the
codes to be used. This information is critical to correct code selec-
tion, and until now, has been unavailable in books other than the
official AMA CPT codebook.
Section guidelines for the pertinent sections of the CPT code-
book (Anesthesia, Surgery, Radiology, Pathology, and Medicine)
appear before the code-detail pages associated with the respec-
tive CPT section. Guidelines that appear elsewhere within a CPT
codebook section are displayed on the code-detail page, whenever
appropriate. The reproduction of anesthesia and pain manage-
ment coding guidelines and parenthetical information in CPT®
Coding Essentials for Anesthesia and Pain Management 2019 is ver-
batim from the AMA CPT codebook.
CPT Codes and Descriptions
CPT codes are listed in numerical order and include anesthesia,
surgery, radiology, laboratory, and medicine codes pertinent to
anesthesia and pain management.
The CPT code set has been developed as stand-alone descrip-
tions of medical services. However, not all descriptions of CPT
codes are presented in their complete form within the code set. In
some cases, one or more abbreviated code descriptions (known as
CPT® Coding Essentials for Anesthesia and Pain Management 2019
child codes) appear indented and without an initial capital letter.
Such codes refer back to a common portion of the preceding code
description (known as a parent code) that includes a semi-colon (;)
and includes all of the text prior to the semi-colon. An example of
this parent–child code system follows:
00120 Anesthesia for procedures on external, middle, and
inner ear including biopsy; not otherwise specified
00124 otoscopy
00126 tympanotomy
The full descriptions for indented codes 00124 and 00126 are:
00124 Anesthesia for procedures on external, middle, and inner
ear including biopsy; otoscopy
00126 Anesthesia for procedures on external, middle, and inner
ear including biopsy; tympanotomy
When a group of similar codes is found on a code-detailed page in
CPT® Essentials, a full description of each code will be displayed.
Icons
Icons on the code-detail page may affect ICD or CPT codes. The
male (|) and female (~) edit icons are applied to ICD codes. New
or revised CPT codes are identified with a bullet (●) or triangle
(▲), respectively. The plus sign (Ã) identifies add-on codes. Add-
on codes may never be reported alone, but are always reported
secondarily to the main procedure, and should never be reported
with modifier 51, Multiple Procedures.
A bullet with the numeral 7 within it (7) is displayed next to
ICD-10-CM codes that require a seventh character. Consult the
ICD-10-CM codebook for appropriate seventh characters.
The bolt symbol (~) identifies CPT codes for vaccines pending
FDA approval.
The star symbol (Í) identifies CPT codes that may be used to
report telemedicine services when appended by modifier 95.
The right/left arrows symbol (⇄) identifies where the full range of
lateral codes would be appropriate. In an effort to conserve space
in the CPT® Coding Essentials series, we have chosen to use this
icon to denote laterality.
New to this 2019 edition of the CPT® Coding Essentials series is
an icon () to denote the CPT® QuickRef, a mobile app created
by the AMA and available from the App Store and Google Play.
The icon indicates that additional dynamic information can be
accessed within the app (in-app purchases required).
Parenthetical Information
The CPT code set sometimes provides guidance in the form of a
parenthetical instruction. For example:
(For donor nephrectomy, use 00862)
Code-detail pages include parenthetical instructions specific to
both the code and the section within which the code is placed
within the CPT code set. Not all codes and/or sections have asso-
ciated parenthetical statements.
CPT® Assistant References
CPT® Assistant is a monthly newsletter published by the AMA
that provides supplemental guidance to the CPT codebook. If
 7
Introduction
a CPT code is the subject of discussion in a past issue of CPT®
Assistant, the volume and page numbers are noted beneath the
code to direct readers to the relevant newsletter archives to keep
abreast of compliant coding rules.
Plain English Description
A simple description of what is included in the service repre-
sented by each CPT code is provided as a guide for coders to
select the correct CPT code while reading the medical record.
Not all approaches or methodologies are described in the Plain
English Description; rather, the most common approaches or
methodologies are provided. In some cases, the description pro-
vides an overview to more than one code, as some code-detail
pages have multiple codes listed.
Illustrations
Streamlined line drawings demonstrate the anatomical site of the
procedure, illustrating the basics of the procedure to assist in code
selection. In some cases, not all codes on the code-detail page and
not all approaches or methodologies are captured in the single
illustration.
Diagnostic Code Crosswalk
ICD-10-CM codes commonly associated with the service repre-
sented on the code-detail page are listed with their official code
descriptions. Keep in mind that in some cases, only the most com-
mon diagnoses for a procedure are listed due to space constraints.
While most codes support the medical necessity of the procedure
performed, medical necessity rules vary by payer, and the accept-
ability of these diagnoses for medical necessity purposes cannot
be guaranteed.
The mappings from CPT to ICD-10-CM in CPT® Coding Essentials
for Anesthesia and Pain Management 2019 were prepared by clinical
coding experts.
The most common ICD-10-CM codes appropriate to the proce-
dure or services represented on the code-detail page are provided.
When a seventh character is required for a code, a bullet with
the numeral 7 within it (7) alerts the coder. Sometimes, a sev-
enth character is appended to a code with only three, four, or five
characters. In those cases, place holding Xs are to be appended to
the codes so that only the seventh character must be added. For
example, the following ICD-10-CM diagnosis code:
T88.4 Failed or difficult intubation
requires a seventh character; therefore, it is displayed with six
characters in this manner:
(7) T88.4XX Failed or difficult intubation
Within ICD-10-CM, many diagnoses have different codes based on
laterality (for example, right plantar nerve, left plantar nerve, unspec-
ified plantar nerve). Due to space constraints, not every laterality
code is listed. Rather, a representative code is listed along with an
icon indicating that other laterality code versions are available.
The provided crosswalks are not meant to replace your ICD-10-CM
codebook. Please consult your manual for all seventh characters
needed to complete listed codes and additional laterality choices, as
well as ICD-10-CM coding conventions essential to proper use.
Introduction
Pub 100
CMS Pub 100 (Publication 100-04, “Medicare Claims Processing
Manual”) is an online resource of federal coding regulations that
often relate to CPT coding. If a CPT code or its associated proce-
dure is the topic of discussion in a CMS Pub 100 entry, the Pub 100
reference is noted so that coders may access it online at www.cms.
gov/regulations-and-guidance/guidance/manuals/internet-only-
manuals-IOMs.html.
Payment Grids
Information in the payment grids that appear on the code-detail
pages comes from CMS. These grids identify the base units used
to compute allowable amounts for anesthesia services or the rela-
tive value of providing a specific professional service in relation to
the value of other services, the number of postoperative follow-up
days associated with each CPT code, and other reimbursement
edits. All data displayed in the payment grids are relevant to phy-
sicians participating in Medicare.
Global Period
During the follow-up, or global surgery period, any routine care
associated with the original service is bundled into the original
service. This means that, for example, an evaluation and manage-
ment (E/M) visit to check the surgical wound would not be bill-
able if occurring during the global surgery period.
Possible global periods under Medicare are 0, 10, and 90 days. XXX
indicates that the global period concept does not apply to the service.
Base Units
All Anesthesia charges are based on units. Base unit amounts are
published yearly and are based on the complexity of the case and
the expected workload of the anesthesia provider required to per-
form the work. Base units are then added to time units and then
any modifiers to derive payment.
Relative Value Units (RVUs)
Relative value unit (RVU) data shows the breakout of work,
practice expense (PE), and malpractice expense (MP) associated
with a code, and provides a breakout for the service depending
on whether it was performed in the physician’s office or in a facil-
ity not belonging to the physician. Understandably, the physi-
cian payment for a surgical procedure is reduced if a procedure is
hosted by a facility, as the facility would expect payment to cover
its share of costs. A physician who performs the surgery in his or
her own office is not subject to the same cost-sharing. This cost
difference shows up in the PE column.
The payment information provided is sometimes used to set rates
or anticipate payments. Payment information may be affected by
modifiers appended to the CPT code.
Modifiers
Sometimes, modifiers developed by the AMA and by CMS may be
appended to CPT codes to indicate that the services represented by
the codes have been altered in some way. For example, modifier 26
reports the professional component of a service that has both a pro-
fessional and a technical component. A patient who undergoes an
ultrasound might have a technician perform the ultrasound itself,
while the physician interprets the ultrasound results to determine a
diagnosis. The technician’s service would be reported with the same
8
CPT® Coding Essentials for Anesthesia and Pain Management 2019
ultrasound CPT code as the physician, but the physician would use
modifier 26 to indicate the professional component only, and the
technician would report modifier TC, which is a Healthcare Com-
mon Procedure Coding System (HCPCS) Level II modifier identify-
ing the service as the technical portion only. If the physician performs
the ultrasound and interprets the results, no modifier is required.
When such circumstances affect the code, users may find the
payment information provided for the full code, the professional
services–only code, and the technical component–only code.
Many modifiers affect payment for services or with whom
payment is shared when multiple providers or procedures are
involved in a single surgical encounter. CMS provides definitions
for the payments, based on the number listed in the modifier’s field.
Modifier 50 (bilateral procedure)
0 150% payment adjustment for bilateral procedures does not
apply. If a procedure is reported with modifier 50 or with modi-
fiers RT and LT, Medicare bases payment for the two sides on the
lower of (a) the total actual charge for both sides or (b) 100% of
the fee schedule amount for a single code. For example, the fee
schedule amount for code XXXXX is $125. The physician reports
code XXXXXLT with an actual charge of $100 and XXXXXRT
with an actual charge of $100.
Payment would be based on the fee schedule amount ($125)
because it is lower than the total actual charges for the left and
right sides ($200). The bilateral adjustment is inappropriate for
codes in this category (a) due to physiology or anatomy or (b)
because the code descriptor specifically states that it is a unilateral
procedure and there is an existing code for the bilateral procedure.
1 150% payment adjustment for bilateral procedures applies. If
a code is billed with the bilateral modifier or is reported twice
on the same day by any other means (such as with RT and LT
modifiers or with a 2 in the units field), payment is based for
these codes when reported as bilateral procedures on the lower of
(a) the total actual charge for both sides or (b) 150% of the fee
schedule amount for a single code. If a code is reported as a bilat-
eral procedure and is reported with other procedure codes on the
same day, the bilateral adjustment is applied before any applicable
multiple procedure rules are applied.
2 150% payment adjustment for bilateral procedure does not apply.
RVUs are already based on the procedure being performed as a bilat-
eral procedure. If a procedure is reported with modifier 50, or is
reported twice on the same day by any other means (such as with
RT and LT modifiers with a 2 in the units field), payment is based
for both sides on the lower of (a) the total actual charges by the phy-
sician for both sides, or (b) 100% of the fee schedule amount for a
single code. For example, the fee schedule amount for code YYYYY
is $125. The physician reports code YYYYYLT with an actual charge
of $100 and YYYYYRT with an actual charge of $100.
Payment would be based on the fee schedule amount ($125)
because it is lower than the total actual charges for the left and
right sides ($200). The RVUs are based on a bilateral procedure
because (a) the code descriptor specifically states that the proce-
dure is bilateral, (b) the code descriptor states that the procedure
may be performed either unilaterally or bilaterally, or (c) the pro-
cedure is usually performed as a bilateral procedure.
CPT® Coding Essentials for Anesthesia and Pain Management 2019
3 The usual payment adjustment for bilateral procedures does not
apply. If a procedure is reported with modifier 50, or is reported
for both sides on the same day by any other means (such as with
RT and LT modifiers or with a 2 in the units field), Medicare
bases payment for each side or organ or site of a paired organ on
the lower of (a) the actual charge for each side or (b) 100% of the
fee schedule amount for each side. If a procedure is reported as a
bilateral procedure and with other procedure codes on the same
day, the fee schedule amount for a bilateral procedure is deter-
mined before any applicable multiple procedure rules are applied.
Services in this category are generally radiology procedures or
other diagnostic tests that are not subject to the special payment
rules for other bilateral procedures.
9 Concept does not apply.
Modifier 51 (multiple procedures)
This modifier indicates which payment adjustment rule for mul-
tiple procedures applies to the service.
0 No payment adjustment rules for multiple procedures apply. If
the procedure is reported on the same day as another procedure,
payment is based on the lower of (a) the actual charge or (b) the
fee schedule amount for the procedure.
1 This indicator is only applied to codes with a procedure status
of “D.” If a procedure is reported on the same day as another
procedure with an indicator of 1, 2, or 3, Medicare ranks the pro-
cedures by the fee schedule amount, and the appropriate reduc-
tion to this code is applied (100%, 50%, 25%, 25%, 25%, and
by report). Carriers and Medicare Administrative Contractors
(MACs) base payment on the lower of (a) the actual charge or (b)
the fee schedule amount reduced by the appropriate percentage.
2 Standard payment adjustment rules for multiple procedures
apply. If the procedure is reported on the same day as another
procedure with an indicator of 1, 2, or 3, carriers and MACs rank
the procedures by the fee schedule amount and apply the appro-
priate reduction to this code (100%, 50%, 50%, 50%, 50%, and
by report). MACs base payment on the lower of (a) the actual
charge or (b) the fee schedule amount reduced by the appropriate
percentage.
3 Special rules for multiple endoscopic procedures apply if a pro-
cedure is billed with another endoscopy in the same family (that
is, another endoscopy that has the same base procedure). The base
procedure for each code with this indicator is identified in field
31G of Form CMS-1500 or its electronic equivalent claim. The
multiple endoscopy rules apply to a family before ranking the
family with other procedures performed on the same day (for
example, if multiple endoscopies in the same family are reported
on the same day as endoscopies in another family or on the same
day as a non-endoscopic procedure). If an endoscopic procedure
is reported with only its base procedure, the base procedure is not
separately paid. Payment for the base procedure is included in the
payment for the other endoscopy.
4 Diagnostic imaging services are subject to Multiple Procedure
Payment Reduction (MPPR) methodology. Technical Compo-
nent (TC) of diagnostic imaging services are subject to a 50%
reduction of the second and subsequent imaging services fur-
nished by the same physician (or by multiple physicians in the
 9
Introduction
same group practice using the same group National Provider
Identifier [NPI]) to the same beneficiary on the same day, effec-
tive for services July 1, 2010, and after. Physician Component
(PC) of diagnostic imaging services are subject to a 25% payment
reduction of the second and subsequent imaging services effective
Jan. 1, 2012.
5 Selected therapy services are subject to MPPR methodology.
Therapy services are subject to 20% of the Practice Expense (PE)
component for certain therapy services furnished in office or
other non-institutional settings, and a 25% reduction of the PE
component for certain therapy services furnished in institutional
settings. Therapy services are subject to 50% reduction of the PE
component for certain therapy services furnished in both institu-
tional and non-institutional settings.
6 Diagnostic services are subject to the MPPR methodology. Full
payment is made for the TC service with the highest payment under
the Medicare Physician Fee Schedule (MPFS). Payment is made at
75% for subsequent TC services furnished by the same physician
(or by multiple physicians in the same group practice using the
same group NPI) to the same beneficiary on the same day.
7 Diagnostic ophthalmology services are subject to the MPPR
methodology. Full payment is made for the TC service with the
highest payment under the MPFS. Payment is made at 80% for
subsequent TC services furnished by the same physician (or by
multiple physicians in the same group practice using the same
group NPI) to the same beneficiary on the same day.
9 Concept does not apply.
Modifier 62 (two surgeons)
This field provides an indicator for services for which two sur-
geons, each in a different specialty, may be paid.
0 Co-surgeons not permitted for this procedure.
1 Co-surgeons could be paid. Supporting documentation is
required to establish medical necessity of two surgeons for the
procedure.
2 Co-surgeons permitted. No documentation is required if two
specialty requirements are met.
9 Concept does not apply.
Modifier 66 (surgical team)
This field provides an indicator for services for which team sur-
geons may be paid.
0 Team surgeons not permitted for this procedure.
1 Team surgeons could be paid. Supporting documentation is
required to establish medical necessity of a team; paid by report.
2 Team surgeons permitted; paid by report.
9 Concept does not apply.
Modifier 80 (assistant surgeon)
This field provides an indicator for services for which an assistant
at surgery is never paid.
0 Payment restriction for assistants at surgery applies to this pro-
cedure unless supporting documentation is submitted to establish
medical necessity.
Introduction
1 Statutory payment restriction for assistants at surgery applies to
this procedure. Assistants at surgery may not be paid.
2 Payment restriction for assistants at surgery does not apply to
this procedure. Assistants at surgery may be paid.
9 Concept does not apply.
Because many of the services represented by CPT codes in the
Radiology, Pathology, and Medicine chapters of the CPT code-
book are diagnostic in nature, crosswalks to the ICD-10-CM
code set are too numerous to list. Instead, a narrative description
of the service is followed by RVU, modifier, and global informa-
tion. The official CPT parenthetical information associated with
the CPT code is included as well.
The following page presents a guide to the information contained
within a code-detail page.
HCPCS Level II Codes
The Healthcare Common Procedure Coding System (HCPCS,
pronounced “hick-picks”) is a collection of code sets that are used
to report health care procedures, supplies, and services. HCPCS
Level I codes are CPT codes, developed and copyrighted by the
American Medical Association. HCPCS Level II codes include
alphanumeric codes developed by CMS to report services, pro-
cedures, and supplies not reported with CPT codes. These codes
include; ambulance services; durable medical equipment, pros-
thetics, orthotics, and supplies (DMEPOS); drugs; and quality
measure reporting. HCPCS Level II codes also include American
Dental Association codes for current dental terminology, or CDT
codes, and hundreds of two-character modifiers. These modifiers
are used to identify anatomic sites, describe the provider of care
or supplies, or describe specific clinical findings.
Modifiers
HCPCS Level II and CPT modifiers appropriate to anesthesia
and pain management coding are included in this chapter. A
modifier provides the means to report or indicate that a service
reported with a CPT or HCPCS Level II code has been altered
by some specific circumstance but not changed in its definition
or code. The service may have been greater, or lesser, or may have
been performed by multiple physicians who will share in reim-
bursement for the service. Modifiers also enable health care pro-
fessionals to effectively respond to payment policy requirements
established by other entities, and often affect reimbursement.
Modifiers may be part of the CPT code set or part of the HCPCS
Level II code set. Both types are included in this chapter. CMS
rules specific to the assignment of modifiers are presented in
numeric (CPT modifiers) or alphanumeric order (HCPCS Level
II modifiers).
In addition to modifiers developed by the AMA and by CMS, a
set of modifiers has been developed by the American Society of
Anesthesiologists (ASA) to describe the well-being of the patient
undergoing anesthesia. The modifier section of this book also
describes the ASA physical status modifiers P1 through P6.
10
CPT® Coding Essentials for Anesthesia and Pain Management 2019
Appendices
What follows is an explanation the appendices contained within
CPT® Coding Essentials for Anesthesia and Pain Management 2019.
Appendix A: National Correct Coding Initiative Edits
The National Correct Coding Initiative (CCI) was developed by
CMS to restrict the reporting of inappropriate code combinations
and reduce inappropriate payments to providers. The CCI edits
essentially identify when a lesser code should be bundled into the
parent code and not separately reported, and when two codes are
mutually exclusive. In either case, only one of the codes is eligible
for reimbursement. In other cases, it is only appropriate to report
both codes concurrently if modifier 59 is appended to identify that
one of the codes reported is a distinct procedural service.
Each of the CCI edits presented in this appendix includes a
superscript that identifies how the edit should be applied. With
a superscript of 0 (120010), the two codes may never be reported
together. With a superscript of 1 (120011), a modifier may be
applied and both codes reported, if appropriate. A superscript
of 9 (120019) indicates that the modifier issue is not applicable
to this code pairing, and the two codes should not be reported
together. Remember, the modifier can only be used when the
paired codes represent distinct procedural services. The modifier
would be appended to the lesser of the two codes, as defined by
their RVUs.
The CCI edits for each of the anesthesia and pain management
CPT codes found in this guide are included in this appendix,
listed in numeric order for simple lookup. CCI edits are updated
quarterly. Those listed in this guide are effective Jan. 1, 2019,
through March 31, 2019. Future quarterly CCI edits can be
found online at https://www.cms.gov/Medicare/Coding/Nation-
alCorrectCodInitEd/Version_Update_Changes.html.
Appendix B: Clinical Documentation Checklist
One of the biggest challenges of ICD-10-CM is ensuring that the
clinical documentation from providers is sufficient. There are two
main problems in documentation associated with ICD-10-CM:
• The terminology has in some cases changed from the
old system, and providers may need to adjust their
documentation for clarity
• The level of detail required in ICD-10-CM is much greater
than previously required for code abstraction
The Clinical Documentation Checklist for Anesthesia and Pain
Management was developed to be used as a communication
tool between coder and physician, or as a document that can be
reproduced as a template for documentation by the physician.
Essentially, the checklist identifies those documentation details
required for complete and accurate code selection. For example,
in ICD-10-CM, secondary diabetes is divided into diabetes due
to underlying condition (E08) and diabetes induced by drugs or
chemicals (E09). Furthermore, another category, other specified
diabetes mellitus (E13), has been added. This category is selected
for patients who have monogenic diabetes, which includes maturity
onset diabetes of the young (MODY), postpancreatectomy diabe-
tes, or when the cause of secondary diabetes is not documented.
Type 1 is reported with E10 codes, and type 2 with E11 codes.
 CPT® Coding Essentials for Anesthesia and Pain Management 2019 Introduction
RVUs are national Medicare relative
Official CPT code description(s) Citations for CPT® Assistant are value units, or a breakdown of the
Master code or code family
for the master code(s) enable provided so coders know when costs of medical care based on
for this code-detail page. All
coders to double-check their to seek further information from CPT code. Physician work, practice
information on this page links to
CPT
code selections.
®
Coding Essentials for Anesthesia & Pain Management this authoritative reference.
2019 36430 expense,
expense, malpractice
or crosswalks to this code(s).
and total expense differ for facility

CPT® Procedural Coding

36430 (For chemotherapy of malignant disease, see
96401-96549)
Facility RVUs  and nonfacility, so both are listed.
Code Work PE RVUs
MP may be used to predict or
Total
36430 Transfusion, blood or blood
Facility set fees forFacility
physician payment.
components AMA CPT Assistant 
36430: Aug 97: 18, Nov 99: 32-33, Aug 00: 2, 36430 0.00 0.98 RVUs
0.02 shown1.00
are for physicians
(When a partial exchange transfusion is
Mar 01: 10, Oct 03: 2, Jul 06: 4, Jul 07: 1, Jul participating in the Medicare
performed in a newborn, use 36456) Non-facility RVUs 
17: 4 program. For anesthesia based
Code Work PE Non- codes,
MP base Total Non-are displayed.
units
AMA Coding Guideline Plain English Description Facility Facility
Venous Procedures Blood and blood components include whole blood, 36430 0.00 0.98 0.02 1.00
Venipuncture, needle or catheter for diagnostic platelets, packed red blood cells, and plasma
Parentheticalstudy or intravenous therapy, percutaneous. Modifiers (PAR) 
instructionsThese codes are also used to report the therapy products. Transfusions are performed to replace From the CMS database, key CPT
blood that is lost or depleted due to an injury, Code Mod Mod Mod Mod Mod
that are partasofspecified. For collection of a specimen from an 50 51
code62modifiers
66
affecting
80
relative
surgery, sickle cell disease, or treatment for a values when they indicate multiple
the official CPT
established catheter, use 36592. For collection of malignant neoplasm. Red blood cells are given to 36430 0 0 0 0 1
procedures or multiple providers,
codebook givea specimen from a completely implantable venous increase the number of blood cells that transport Global Period
crucial direction
access device, use 36591. as in co-surgery, team surgery, or
oxygen and nutrients throughout the body, platelets Code Days
to prevent Vascular Introduction and Injection assistant surgery are listed here.
to control bleeding and improve blood clotting, and
coding errors.
Procedures 36430 XXX
plasma to replace total blood volume and provide
Listed services for injection procedures include blood factors that improve blood clotting. The skin
necessary local anesthesia, introduction of is prepped over the planned transfusion site and an The Medicare global period indicates
needles or catheter, injection of contrast media intravenous line inserted. Any medication ordered the number of postoperative days
with or without automatic power injection, and/or by the physician is administered prior to the during which any routine care
Plain English
necessary pre- and postinjection care specifically transfusion. The blood and/or blood components associated with the original service
Descriptions of to the injection procedure.
related are administered. The patient is monitored during is bundled into the original service.
the procedure
Selective vascular catheterization should be coded the transfusion for any signs of adverse reaction. Possible global periods are 0, 10,
or serviceto include introduction and all lesser order selective
and 90 days.
explain what
catheterization used in the approach (eg, the Transfusion, blood or blood components
the master code for a selective right middle cerebral
description
represents,
artery catheterization includes the introduction and Veins
enabling placement
the catheterization of the right common and
coder to internal
verify carotid arteries). Simple line illustrations bring
code selections
Additional second and/or third order arterial clarity and understanding to
against the
catheterization within the same family of arteries or complex procedures.
veins supplied by a single first order vessel should
medical record.
be expressed by 36012, 36218, or 36248.
Additional first order or higher catheterization in
vascular families supplied by a first order vessel Arteries
Transfusion, blood or blood components
different from a previously selected and coded
family should be separately coded using the
conventions described above.
Common diagnoses associated with the procedure
Surgical Procedures on Arteries and
ICD-10-CM Diagnostic Codes are linked to the ICD-10-CM code set. Icons identify
Veins
Primary vascular procedure listings include There are too many ICD-10-CM codes to list. Refer when a seventh character is required, and Xs have
establishing both inflow and outflow by whatever to ICD-10-CM code book for associated diagnostic been added to codes as placeholders to prevent
procedures necessary. Also included is that portion
codes. errors when assigning the seventh character.
of the operative arteriogram performed by the Diagnoses that are limited to one sex are noted
CCI Edits
surgeon, as indicated. Sympathectomy, when done, with an icon. Diagnoses that apply to multiple sides/
Refer to Appendix A for CCI edits.
is included in the listed aortic procedures. For regions of the body are noted with an icon.
unlisted vascular procedure, use 37799. Pub 100
Please see the Surgery Guidelines section for the 36430: Pub 100-03, 1, 110.16, Pub 100-03, 1,
following guidelines: 110.7, Pub 100-04, 4, 231.8
• Surgical Procedures on the Cardiovascular
System

AMA Coding Notes

Vascular Introduction and Injection
Procedures
(For radiological supervision and interpretation, see
Radiology)
(For injection procedures in conjunction with
cardiac catheterization, see 93452-93461, 93563-
93568)

● New ▲ Revised à Add On Modifier 51 Exempt ÍTelemedicine  CPT QuickRef ~FDA Pending ⇄ Laterality 7Seventh Character |Male ~Female
CPT © 2018 American Medical Association. All Rights Reserved. 483

 11
Introduction CPT® Coding Essentials for Anesthesia and Pain Management 2019

Appendix C: Documentation Guidelines for

Evaluation and Management (E/M) Services
As the author and owner of E/M codes found in the CPT code-
book, the AMA has developed detailed guidelines on how to
determine which code is appropriate to report, based on the med-
ical record for the encounter. These guidelines look at the quality
and quantity of the data in the record:
• History
• Examination
• Medical decision making
• Counseling
• Coordination of care
• Nature of the presenting problem
• Length of the visit
In 1995, CMS published its own Documentation Guidelines
(DGs). Recognizing that the 1995 DGs did not appropriately
reflect the work performed in some specialties, CMS published
a second set of DGs in 1997. Both sets are still in use. The 1995
DGs are appropriate for multi-system examinations; for example,
an internal medicine physician. The 1997 DGs are appropriate
for in-depth, single-system examinations, for example, from a
retinal specialist.
For Medicare and Medicaid, either the 1995 or 1997 DGs are
to be followed, depending on the preference of the provider or
coder. The CPT guidelines, while largely incorporated into the
1995 and 1997 DGs, still have unique features accepted by some
private payers. Unabridged copies of all three sets of DGs are pre-
sented in Appendix C.

12
 Terminology
Terminology&&Abbreviations
Terminology, Abbreviations, and Basic Anatomy

Abbreviations
The Terminology, Abbreviations, and Basic Anatomy chapter can Root Words/Combining Forms
be used as a reference tool if there is confusion when reading abdomin/o abdomen
medical record documentation and when a more extensive acous/o hearing
understanding of medical terminology is needed. The following
acr/o extremities, top, extreme point
includes terms, abbreviations, symbols, prefixes, suffixes, and
anatomical illustrations that will help clarify some of the more aden/o gland
difficult issues, and give a firmer understanding of information, adip/o fat
that is in medical record documentation. andr/o male
ankyl/o stiff, bent, crooked
Medical Terminology anter/o front
A majority of medical terms are composed of Greek and Latin arthr/o joint
word parts and are broken down into different elements. One ather/o yellowish, fatty plaque
element is the root word. The root word is the foundation of audi/o hearing
the medical term and contains the fundamental meaning of the aur/o ear
word. All medical terms have one or more roots. aut/o self
Examples: axill/o armpit
hydr = water balan/o glans penis
bi/o life
lith = stone
blast/o developing cell
path = disease
blephar/o eyelid
Combining forms (or vowel, usually “o”) links the root word to brach/o arm
the suffix or to another root word. This combining vowel does
bronch/o bronchial tubes
not have a meaning on its own; it only joins one part of a word
to another. carcin/o cancer
card/o heart
Prefixes and suffixes are two of the other elements used in medical cheil/o lip
terminology and consist of one or more syllables (prepositions or
chol/o gall, bile
adverbs) placed before or after root words to show various kinds
of relationships. Prefixes are before the root word and suffixes are cholangi/o bile duct
after the root word and consist of one or more letters grouped chondr/o cartilage
together. They are never used independently; however, they can cis/o to cut
modify the meaning of the other word parts. Many prefixes and colp/o vagina
suffixes are added to other words with a hyphen, but medical coron/o heart
dictionary publishers are opting to drop the hyphen on many of cost/o ribs
the more common prefixed medical words.
crani/o skull
Examples: cry/o cold
Prefixes: cutane/o skin
micro = small cyan/o blue
peri = surrounding cyt/o cell
Suffixes: cyst/o urinary bladder
dacry/o tear duct, tear
algia = pain
derm/o skin
an = pertaining to
dermat/o skin
The following are lists of prefixes and suffixes typically seen in dipl/o double, two
Anesthesia/Pain Management:
dips/o thirst
dist/o distant, far

 13
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

ech/o sound oophor/o ovary

encephal/o brain opt/o eye
enter/o intestine ophthalm/o eye
erythr/o red or/o mouth
erythem/o red orch/o testis
eti/o cause of disease orchi/o testis
galact/o milk orchid/o testis
gastr/o stomach orth/o straight
gloss/o tongue oste/o bone
gluc/o sugar ot/o ear
glyc/o sugar ov/o egg
gon/o seed ovul/o egg
gravid/o pregnancy pachy/o thick
gynec/o female, woman path/o disease
hemat/o blood phag/o to eat, swallow
hepat/o liver phleb/o vein
hidr/o sweat phon/o voice
hist/o tissue phot/o light
home/o sameness phren/o diaphragm
inguin/o groin plas/o formation, development
isch/o to hold back pneumon/o lungs
kal/o potassium poli/o gray matter
kerat/o horny tissue, hard proct/o rectum and anus
labi/o lip pulmon/o lungs
lapar/o abdomen, abdominal psych/o mind
laryng/o larynx py/o pus
lei/o smooth quadr/o four
leuk/o white ren/o kidney
lingu/o tongue rhin/o nose
lith/o stone rhytid/o wrinkle
lord/o swayback, curvature in lumbar region rhiz/o nerve root
mamm/o breast salping/o fallopian tubes
mast/o breast sial/o salivary gland
melan/o black sarc/o flesh
ment/o mind sect/o to cut
metr/o uterus spir/o breathing
morph/o shape, form spondyl/o vertebra
my/o muscle squam/o scale-like
myc/o fungus staphyl/o clusters
myel/o spinal cord steat/o fat
myring/o eardrum strept/o twisted chains
natr/o sodium terat/o monster
necr/o death (of cells or all of the body) thec/o sheath
nephr/o kidney thorac/o chest
neur/o nerve thromb/o clot
noct/o night trich/o hair
odont/o tooth tympan/o eardrum
olig/o few, scanty ung/o nail
omphal/o naval, umbilicus vas/o vessel
onc/o tumor ven/o vein
onych/o nail viscer/o internal organs

14
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

xanth/o yellow hex- six
xer/o dry homo- same
Prefixes hyper- above, excessive
a(d)- towards hypo- below, deficient
a(n)- without im-, in- not
ab- from in- into, to
ab(s)- away from infra- below, underneath
ad- towards inter- among, between
allo- other, another intra- within, inside, during
ambi- both intro- inward, during
amphi- on both sides, around iso- equal, same
ana- up to, back, again, movement from juxta- adjacent to
aniso- different, unequal kata- down, down from
ante- before, forwards macro- large
anti- against, opposite magno- large
ap-, apo- from, back, again medi- middle
bi(s)- twice, double mega- large
bio- life megalo- very large
brachy- short meso- middle
cata- down meta- beyond, between
circum- around micro- small
con- together neo- new
contra- against non- not
cyte- cell ob- before, against
de- from, away from, down from octa- eight
deca- ten octo- eight
di(s)- two oligo- few
dia- through, complete pachy- thick
di(a)s separation pan- all
diplo- double para- beside, to the side of, wrong
dolicho- long pent- five
dur- hard, firm per- by, through, throughout
dys- bad, abnormal peri- around, round-about
e-, ec- out, from out of pleo- more than usual
ecto- outside, external poly many
ek- out post- behind, after
em- in pre- before, in front, very
en- into pros- besides
endo- into prox- besides
ent- within pseudo- false, fake
epi- on, up, against, high quar(r)- four
eso- will carry re, red- back, again
eu- well, abundant, prosperous retro- backwards, behind
eury- broad, wide semi- half
ex-, exo- out, from out of sex- six
extra- outside, beyond, in addition sept- seven
haplo- single sub- under, beneath
hapto- bind to super- above, in addition, over
hemi- half supra- above, on the upper side
hept- seven syn- together, with
hetero- different sys- together, with

 15
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

tetra- four Anesthesia/Pain Management Terms

thio- sulfur The following definitions are medical terms commonly seen while
trans- across, beyond coding/billing for Anesthesia/Pain Management:
tri- three Acupressure – A therapy developed by the ancient Chinese and
uni- one used in eastern cultures for thousands of years. Practitioners apply
ultra- beyond, besides, over varying physical pressure, through touch, to specific body sites in
order to channel and stimulate energy flow.
Suffixes
-ase fermenter Acupuncture – An ancient Chinese practice, using needles
inserted into specific sites in the body, along “meridians,” to
-ate do
stimulate body systems. This therapy is used for a wide variety
-cide killer of purposes including relaxation, pain relief, and treating illness
-c(o)ele cavity, hollow and disease.
-ectomy removal of, cut out Acute Pain – The physiological response to trauma, injury,
-form shaped like surgery or illness. It is generally time limited from days to weeks.
-ia got Adjuvant – Generally used to describe an “add-on” or additional
-iasis full of therapy.
-ile little version Adjuvant Analgesic – Generally used to describe drugs that have
-illa little version a primary use other than pain control but have secondary pain-
-illus little version relieving qualities.
-in a substance, chemical, chemical compound Algology – The science and study of pain.
-ism theory, characteristic of Allodynia – Pain due to a stimulus that does not normally provoke
-itis inflammation pain. The original definition adopted by the IASP committee was
-ity makes a noun of quality pain due to non-noxious stimulus to the normal skin. Allodynia
-ium thing involves a change in the quality of a sensation, tactile, thermal,
or of any other kind. The usual response to a stimulus was not
-ize do painful, but the present response is.
-logy study of, reasoning about
Analgesia – Absence of pain in response to stimulation that
-megaly large would normally be painful.
-noid mind, spirit
Analgesic – Generally refers to a pain relief medication; also a
-oid resembling, image of pain-relieving effect, such as “the acupuncture was analgesic.”
-ogen precursor
Anesthesia – The absence of sensation, either in a region of
-ol(e) alcohol skin, a region of the body, or as a total loss of consciousness.
-ole little version “Local” anesthesia affects (numbs) a specific area of the body and
-oma tumor (usually) “general” anesthesia results in unconsciousness; anesthesiologist
-osis full of induces sleep and maintains unconsciousness to avoid sensation.
-ostomy “mouth-cut” Anesthesia Dolorosa – Where pain is present in an area that is
-pathy disease of, suffering anesthetic.
-penia lack Anesthesia – A medical specialty devoted to the science of
-pexy fix in place anesthesia; a subspecialty of Anesthesia is the study of pain
-plasty re-shaping control drugs and procedures.
-philia affection for Anesthetic – An agent or agents that produce regional
-rhage burst out anesthesia (certain part of the body) or general anesthesia (loss of
consciousness).
-rhea discharge, flowing out
Angina – Usually pain syndromes associated with cardiac disease.
-rhexis shredding
May indicate a feeling of oppression or tightness of the chest or
-pagus Siamese twins throat.
-sis idea (makes a noun, typically abstract)
Anterior – A term used by medical professionals meaning at the
-thrix hair front of, or close to the front of the body. (See Posterior)
-tomy cut
Anticonvulsants – Group of drugs used to prevent seizures, also
-ule little version used as adjuvant analgesics in chronic pain treatment to alter
-um thing (makes a noun, typically concrete) transmission of the pain signal.
Arthralgia – Pain in a joint, usually due to arthritis.

16
CPT® Coding Essentials for Anesthesia and Pain Management 2019
Arthritis – Basically, chronic or ongoing inflammation of a joint.
There are many different arthritic conditions because it lacks the
negative stigma associated with the term “narcotics.”
Biofeedback – A non-drug technique used to treat a wide
variety of pain conditions. A non-invasive electronic device is
used to monitor various biologic responses (such as heart rate).
Information is gathered, and then used to teach the patient
various control techniques.
Causalgia – A syndrome of sustained burning pain, allodynia,
and hyperpathia after a nerve injury, often combined with
vasomotor and sudomotor dysfunction and later trophic changes.
Central Pain – Pain associated with a lesion of the central nervous
system.
Chronic – Long term or ongoing.
Chronic Pain – An ongoing or persistent pain syndrome;
generally lasting more than six months.
Complex Regional Pain Syndrome – Chronic pain condition
that can affect any area of the body. It is subdivided into two
types. Type 1 is typically triggered by an injury, often minor, that
does not directly involve the nerves. It may also be triggered by an
illness or have no known cause. Type 2, more commonly referred
to as causalgia, is the result of an injury to a nerve. Both types
are characterized by neuropathic pain that can be severe or even
disabling. In addition, the affected body site, which is usually
an extremity, may show evidence of sympathetic nervous system
changes such as abnormal circulation, temperature, and sweating.
Loss of function of the extremity, muscle atrophy, and hair and
skin changes may also eventually occur.
Contraindicated – A term frequently used in pain management
to mean that a medication or treatment is not to be used in a
specific patient because it may cause serious side effects or
reactions.
Cutaneous – Generally referring to the skin and/or the tissues
directly underneath the skin.
Cutaneous Intervention – A variety of treatments through the
skin used to promote healing or pain relief, including heat, cold,
massage, acupressure, ultrasound, hydrotherapy, TENS, and
vibration.
Deafferentation Pain – Pain due to loss of sensory input into the
central nervous system (as can occur with avulsion of the brachial
plexus), or other types of peripheral nerve lesions. Can also be
due to pathologic lesions of the central nervous system.
Dermatome – A term related to very specific sections of the body
that are associated with the distribution of the large nerves coming
from the spine. Dermatomes are helpful in locating which area in
the spine is malfunctioning.
Dysesthesia – An abnormal unpleasant sensation, can be
spontaneous or evoked. A dysesthesia is always unpleasant. The
patient must decide whether a sensation is pleasant or unpleasant.
Edema – Swelling; generally, an abnormal accumulation of body
fluids, often accompanying inflammation.
Endorphin – A substance the body manufactures that acts like
morphine in the brain and central nervous system. This natural
pain-relieving agent can be stimulated by exercise.
 17
Terminology, Abbreviations, and Basic Anatomy
Terminology & Abbreviations
Epidural Space – A space located between the spinal cord and
the vertebral column in the spine.
Epidural Steroid Injection – An injection of steroid medication
into the epidural space of the spine; used in some forms of back
pain.
Epidurogram – An x-ray test using contrast dye to confirm
epidural catheter placement and obtain information about a
patient’s epidural space.
Fibromyalgia – A muscle and connective tissue disorder
characterized by symptoms of pain, tenderness, and stiffness of
tendons, muscles, and surrounding soft tissue.
Fibrosis – Scarring of tissue; abnormal formation of fibrous
tissue.
General Anesthesia – During surgery, using a mixture of
medications and gas, a gradual titration of the medication under
the direction of the physician.
Hyperalgesia – An increased response to a stimulus that is
normally painful.
Hyperesthesia – Increased sensitivity to any stimulation.
Hyperpathia – Abnormally exaggerated subjective response to
painful stimuli. May occur with hyperesthesia, hyperalgesia, or
dysesthesia. The pain is often explosive in character.
Hypoalgesia – Diminished sensation to noxious stimulation.
Hypoesthesia – Abnormally decreased sensitivity, particularly to
touch in its absence.
Intramuscular (IM) – An injection of medication or fluids into
a muscle.
Intravenous (IV) – An injection of medication or fluids into a
vein.
Migraine Aura, Persistent, without Cerebral Infarction –
This is a rare complication of a migraine and is characterized by
the presence of a migraine aura lasting for more than one week
without radiographic evidence of a cerebral infarction.
Migraine, Chronic – A diagnosis of chronic migraine is made
when a patient has 15 or more headache days per month.
Migraine, Episodic – The term episodic migraine may be used to
differentiate a patient who does not have chronic migraines from
one who does. This term is not used in ICD-10-CM codes.
Migraine, Hemiplegic – Symptoms are the same as a migraine
with aura. In addition, the migraine is accompanied by muscle/
motor weakness. Hemiplegic migraines are further differentiated
as familial or sporadic. A familial hemiplegic migraine is one in
which the patient has at least one first- or second-degree family
member who has also been diagnosed with hemiplegic type
migraines. Sporadic hemiplegic migraine is one in which the
patient does not have any first or second degree family members
who have also been diagnosed with hemiplegic type migraines.
Migraine with Aura – Symptoms are the same as a migraine
without aura. In addition, the migraine is accompanied by visual,
sensory, or speech disorders.
Migraine without Aura – The most common type of migraine.
Symptoms typically include: unilateral headache, pulsating
pain, moderate to severe in intensity, aggravated by physical
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy
activity, associated with nausea/vomiting, sensitivity to light
(photophobia) and/or sound (phonophobia), duration typically
4-72 hours.
Myopathy – Any abnormal disease or condition of muscle tissue,
often involving pain.
Myotome – A term related to sections of the body that are
associated with a muscle or muscle group including the insertions
sites at either end of the muscle fibers.
Nervous System – The organs and tissues of the body that provide
for communication with other body systems and including
the higher centers of reasoning; the brain and spinal cord are
components of the central nervous system, and the nerves outside
those structures make up the peripheral nervous system.
Neuralgia – Pain in the distribution of a specific nerve or nerves.
Neuritis – Acute and/or chronic inflammation of nerves.
Neuropathic Pain – Pain syndrome in which the predominant
mechanism is aberrant somatosensory processing. May be
restricted to pain originating in peripheral nerves and nerve roots.
Neuropathy – A functional disturbance or pathological change
in the peripheral nervous system, sometimes limited to non-
inflammatory lesions as opposed to neuritis.
Nociceptor – A receptor for pain, preferentially sensitive to a
noxious stimulus or to a stimulus that would become noxious if
continued. Pain is a perception that takes place at higher levels of
the central nervous system.
Non-Steroidal Anti-inflammatory Drug (NSAID) – This is a
specific class of drugs that reduces inflammation and swelling
in and around the site of injury or irritation. These drugs (such
as ibuprofen) are widely used in acute pain management and in
chronic inflammatory conditions such as arthritis.
Noxious Stimulus – Stimulus that is potentially or actually
damaging to body tissue.
Opioid – A narcotic used to help treat pain.
Osteoarthritis – The most common form of arthritis often
associated with aging. It may occur in one joint or in many and is
often degenerative in nature.
Pain – Sensation of discomfort, distress, or agony, resulting
from the stimulation of specialized nerve endings. It serves
as a protective mechanism (induces the sufferer to remove or
withdraw).
Pain Threshold – Pain threshold is the least experience of pain
that a subject can recognize.
Pain Tolerance Level – The greatest level of pain that a patient
is able to tolerate.
Paresthesia – An abnormal sensation, such as burning, or
prickling, that may be spontaneous or in response to stimulus. It
has the same clinical limitations as the pain tolerance level.
Patient-Controlled Analgesia (PCA) – An intravenous drug
delivery system, generally used after surgery, that allows patients
to control the amount of pain medicine they receive, by pushing
a button that causes the system to administer a dose of medicine.
Patients are taught to administer pain medication depending on
the level of pain. This method has been shown to provide effective
pain relief using less medication.
18
CPT® Coding Essentials for Anesthesia and Pain Management 2019
Physiological Dependence – A condition that occurs with
opioids and other drugs whereby the body becomes accustomed
to a chemical. Often confused with addiction or psychological
dependence, this condition is common and not associated with
drug abuse. The hallmark of physiological dependence is the need
to avoid abrupt discontinuation of the drug, which will cause a
predictable withdrawal syndrome. Discontinuation of the drug
can be easily accomplished by tapering the dose of the medication
slowly under the direction of the physician.
Posterior – Close to, or at the back of the body. Also called
“dorsal.”
Pruritus – Itching.
Pseudoaddiction – A drug seeking behavior pattern of pain
patients who are not getting adequate pain relief. For example, a
patient is given a pain pill that only last for four hours, but only
allowed to take it every six hours. This behavior can be mistaken
for addiction and other psychological and behavioral factors,
including overwhelming obsession with obtaining and using
drugs, despite harm to self or others. Addiction is feared, but very
rare in chronic pain analgesic users. Also known as “psychological
dependence.”
Psychosomatic – A term used to describe a physical disorder
thought to be caused partly or entirely by psychological problems.
Radiculalgia – Pain along the distribution of one or more sensory
nerve roots.
Radiculitis – Inflammation of one or more nerve roots.
Radiculopathy – A usually painful disturbance of function or
pathologic change in one or more spinal nerve roots.
Referred Pain – Pain that is felt in a place different from the place
of origin. For example, pain from pressure in the liver is often felt
in the right upper chest or shoulder.
Somatosensory – Pertaining to sensations received from all
tissues of the body (skin, muscles).
Sonogram – Using high frequency sound waves. Also a technique
to apply heat during physical therapy.
Titration – Increasing or decreasing a medication in an
incremental manner, to reach a desired level. This method is used
to allow the body to adjust, or to find an effective dose. Titration
is used with anti-depressants, steroids, opioids and other drugs.
Tolerance – A physiological phenomenon that develops in some
patients with long term opioid use where the body requires
increasing amounts of drug to achieve the same level of effect.
There are several theories that may explain tolerance including the
body becoming a more effective metabolizer of the medication,
and the body making less receptor sites for a drug after long
exposure. Often confused with addiction.
Transcutaneous Electrical Nerve Stimulation (TENS) – A
cutaneous intervention that relieves pain by sending electrical
stimulation to nerve fibers and interfering with pain signal
transmission. This method employs electrodes placed on the skin
in various locations, using various degrees of intensity to achieve
pain relief.
Transdermal – Referring to delivery through the skin. Patches
that deliver medication are transdermal.
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

Trigger Point – A hypersensitive area in muscle or connective Ana up, back, again, excessive, Anatomy, (a cutting up); anagenes
tissue with pain locally as well as referred pain and tenderness. (reproduction of tissue); anasarca (excessive serum in cellular tissues of
body)
Withdrawal – A syndrome that occurs when opioids and some
other drugs are abruptly discontinued, or a condition marked by Ante before, forward, Antecubital, (before elbow); anteflexion, (forward
a pattern of behavior observed in schizophrenia and depression, bending)
characterized by a pathological retreat from interpersonal content Anti against, opposed to, reversed Antiperistalsis (reversed peristalsis);
and social involvement and leading to pre-occupation. antisepsis (against infection)
AP apical pulse
Abbreviations/Acronyms Apo from, away from Aponeurosis (away from tendon); apochromatic
(abnormal color)
The following abbreviations and acronyms are commonly seen in
documentation for Anesthesia/Pain Management: APSGN acute poststreptococcal glomerulonephritis
ARF acute renal failure
A without, lack of, Apathy (lack of feeling); apnea (without breath); aphasia
(without speech); anemia (lack of blood) AS aortic stenosis

A&P anterior and posterior; auscultation and percussion ASCVD arteriosclerotic cardiovascular, disease

Ab antibody ATN acute tubular necrosis

ab away from, Abductor, (leading away from); aboral (away from mouth) AU both ears

Abd abdomen AV aortic valve

ABG arterial blood gases AVB atrio-ventricular block

ABP arterial blood pressure AVR aortic valve replacement

Ac before meals BE barium enema

ACBG aortocoronary bypass graft BBS bilateral breath sounds

ACE angiotensin converting enzyme BG blood glucose

ACL anterior cruciate ligament BI brain injury

ACT anticoagulant therapy; active motion bi twice, double Biarticulate (double joint); bifocal (two foci); bifurcation
(two branches)
ACTH adrenocorticotropic hormone
BID twice a day
Ad to, toward, near to, Adductor, (leading toward); adhesion, (sticking to);
adnexa (structures joined to); adrenal (near the kidney) bilat bilateral

ADH antidiuretic hormone B/K below knee

ADL activities of daily living BM bowel movement or breast milk

Ad lib as desired BMR basal metabolic rate

AFB acid-fast bacilli BP blood pressure

AFIB atrial fibrillation BPH benign prostatic hypertrophy

AFP alpha-fetoprotein Brachy short

AGA appropriate for gestational age BRP bathroom privileges

AI aortic insufficiency BS bowel sounds

AICD automated implantable cardio-defibrillator BSA body surface area

AIDS acquired immune deficiency syndrome BSE breast self-examination

AKA above knee amputation BT bowel tones

Allo other, another BUN blood urea nitrogen

ALP alkaline phosphatase bx biopsy

AMA against medical advice C Celsius(centigrade)

AMB ambulatory c (C) with

Ambi both, Ambidextrous, (ability to use hands equally); ambilateral (both sides) C&S culture and sensitivity

AMI acute myocardial infarction c/o complaint of

Amphi about, on both sides, both, Amphibious, (living on both land and water) Ca calcium, cancer, carcinoma

Ampho both, Amphogenic, (producing offspring of both sexes) CA cardiac arrest

a(n) without CABG coronary artery bypass graft

CAD coronary artery disease

 19
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

CAPD continuous ambulatory peritoneal dialysis D5W Dextrose 5% in water

CAT computerized tomography scan D5LR Dextrose 5% with lactated ringers
Cata down, according to, complete Catabolism (breaking down); catalepsia DAT diet as tolerated
(complete seizure); catarrh (flowing down)
DBP diastolic blood pressure
CATH LAB cardiac catheterization lab
DC (dc) discontinue
CBC complete blood count
DEX (DXT) blood sugar
CBD common bile duct
De Away from, Dehydrate (remove water from); dedentition (removal of
CBE clinical breast examination teeth); decompensation (failure of compensation)
CBI continuous bladder irrigation deca ten
CBR complete bed rest Di Twice, double, Diplopia (double vision); dichromatic (two colors); digastric
(double stomach)
CC chief complaint
Dia Through, apart, across, completely Diaphragm (wall across); diapedesis
CCK cholecystokinin (ooze through); diagnosis (complete knowledge)
CCPD continuous cyclic peritoneal dialysis DIC disseminated intravascular coagulation
CCU cardiac care unit Diplo double
CD cardiovascular disease Dis Reversal, apart from, separation disinfection (apart from infection);
CEA cultured epithelial autograft disparity (apart from equality); dissect (cut apart)
CFT complement-fixation test DKA diabetic ketoacidosis
CHD coronary heart disease DM diabetes mellitus
CHF congestive heart failure DNA deoxyribonucleic acid
CI cardiac insufficiency DNR do not resuscitate
CICU cardiac intensive care unit DTR deep tendon reflex
CIHD chronic ischemic heart disease DVT deep vein thrombosis
Circum Around, about Circumflex (winding about); circumference (surrounding); Dx diagnosis
circumarticular (around joint) Dys Bad, difficult, disordered, Dyspepsia (bad digestion); dyspnea (difficult
CMS circulation, motion, sensation breathing); dystopia (disordered position)
CO cardiac output E, ex Out, away from, Enucleate (remove from); eviscerate (take out viscera or
bowels); exostosis (outgrowth of bone)
Com With, together, Commissure (sending or coming together)
EBV Epstein-Barr Virus
Con With, together, Conductor (leading together); concrescence (growing
together); concentric (having a common center) Ec Out from, Ectopic (out of place); eccentric (away from center); ectasia
(stretching out or dilation)
Contra Against, opposite Contralateral (opposite side); Contraception (prevention
of conception); contraindicated (not indicated) ECF extracellular fluid, extended care facility
CO2 carbon dioxide ECG (EKG) electrocardiogram/electrocardiograph
COPD chronic obstructive pulmonary disease Ecto On outer side, situated on Ectoderm (outer skin); ectoretina (outer layer
of retina)
CP chest pain, cleft palate
EENT eye, ear, nose and throat
CPAP continuous positive airway pressure
Em, en. Empyema (pus in); encephalon (in the head)
CPR cardiopulmonary resuscitation
EMG electromyogram
CPPD chest percussion and post drainage
Endo Within, Endocardium (within heart); endometrium (within uterus)
CRF chronic renal failure
Ent within
CRPS complex regional pain syndrome
Epi Upon, on, Epidural (upon dura); epidermis (on skin)
CRRT continuous renal replacement therapy
ERCP endoscopic retrograde cholangiopancreatography
CRT capillary refill time
ESRD end stage renal disease
CSF cerebrospinal fluid, colony stimulating factors
ET endotracheal tube
CT chest tube, computed tomography
Exo Outside, on outer side, outer layer, Exogenous (produce outside); exocolitis
CVA cerebral vascular accident, costovertebral angle (inflammation of outer coat of colon)
CVP central venous pressure Extra Outside, Extracellular (outside cell); extrapleural (outside pleura)
CX circumflex F&R force and rhythm
Cx’d cancelled FA fatty acid
CXR chest x-ray FBS fasting blood sugar

20
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

FD fatal dose, focal distance ICT inflammation of connective tissue
FDA Food & Drug Administration ICU intensive care unit
Fx fracture IDDM insulin dependent diabetes mellitus
FUO fever of unknown origin IE inspiratory exerciser
FVD fluid volume deficit IH infectious hepatitis
GB gallbladder IHD ischemic heart disease
GFR glomerular filtration rate IHR intrinsic heart rate
GI gastrointestinal IIP implantable insulin pump
GU genitourinary IM intramuscular
HA headache Im, in In, Into, Immersion (act of dipping in); infiltration (act of filtering in);
injection (act of forcing liquid into)
Haplo single
Imp impression
Hapto bind to
IMV intermittent mandatory ventilation
Hb hemoglobin
Infra Below, Infraorbital (below eye); infraclavicular (below clavicle or
HCG human chorionic gonadotropin collarbone)
HCVD hypertensive cardiovascular disease Inter Between, Intercostal (between ribs); intervene (come between)
HCO3 bicarbonate Intra Within, Intracerebral (within cerebrum); intraocular (within eyes);
HCT hematocrit intraventricular (within ventricles)
HD heart disease, hemodialysis Intro Into, within, Introversion (turning inward); introduce (lead into)
HDL high density lipoprotein IPD intermittent peritoneal dialysis
HEENT head, eye, ear, nose and throat IPPB intermittent positive pressure breathing
Hemi Half, Hemiplegia (partial paralysis); hemianesthesia (loss of feeling on one Iso equal, same
side of body) ITP immune thrombocytopenic purpura
hept seven IV intravenous
hetero different IVF in vitro fertilization
hex six IVP intravenous pyelography
Hgb hemoglobin JAMA Journal of the American Medical Association
HIV human immunodeficiency virus Juxta adjacent to
HM heart murmur JVP jugular venous pressure
h/o history of K potassium
homo same Kata down, down from
HPI history of present illness KCl potassium chloride
HRT hormone replacement therapy KI potassium iodide
HS hour of sleep KUB kidney, ureter, bladder
HTN (BP) hypertension KVO keep vein open
Hx history L&A light and accommodation
Hyper Over, above, excessive Hyperemia (excessive blood); hypertrophy LB large bowel
(overgrowth); hyperplasia (excessive formation)
LDL low density lipoprotein
Hypo Under, below, deficient Hypotension (low blood pressure); (deficiency or
underfunction of thyroid) LE lupus erythematosus
I&O intake and output LFTs liver function tests
IBC iron binding capacity LLQ left lower quadrant
IBD inflammatory bowel disease LMP last menstrual period
IBS irritable bowel syndrome LP lumbar puncture
IBW ideal body weight LUQ left upper quadrant
ICCE intracapsular cataract extraction Lytes electrolytes
ICF intermediate care facility Macro large
ICP intracranial pressure Magno large
ICS intercostal space MAP mean arterial pressure

 21
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

MAR medication administration record OOB out of bed

MDI multiple daily vitamin Opistho Behind, backward, Opisthotic (behind ears); opisthognathous (beyond
jaws)
Medi middle
ORIF open reduction internal fixation
Mega large
OS left eye
Megalo very large
OT occupational therapy
Meso middle
OU both eyes
Meta Beyond, after, change Metamorphosis (change of form); metastasis change
(beyond original position); metacarpal (beyond wrist) P after
MI myocardial infarction P pulse
Micro small PABA para-aminobenzoic acid
MLC midline catheter Pachy thick
MM mucous membrane Pan all
MoAbs monoclonal antibodies Para Beside, beyond, near to Paracardiac (beside the heart); paraurethral (near
the urethra)
MOM Milk of Magnesia
PCA patient controlled analgesia, posterior communicating artery
MRDD mental retarded/developmentally disabled
PCN penicillin, primary care nurse
MRI magnetic resonance imaging
PCV packed cell volume
MRM modified radical mastectomy
PD peritoneal dialysis
MS multiple sclerosis, morphine sulfate
PDA patent ductus arteriosus
MV Mitral Valve
PDD pervasive development disorder
MVP mitral valve prolapse
PDR physician’s desk reference
Na sodium
PE physical examination
NaCl sodium chloride
PEG percutaneous endoscopic gastrostomy
NAD no apparent distress
PEJ percutaneous endoscopic jejunostomy
NED no evidence of disease
Peri around, Periosteum (around bone); periatrial. (around atrium);
Neg negative
peribronchial (around bronchus)
Neo new
PERL pupils equal, react to light
NICU neonatal intensive care unit
Permeate (pass through); perforate (bore through); peracute (excessively acute)
NIDDM noninsulin dependent diabetes mellitus
PERRLA pupils equal, round, react to light, accommodation
NKA no known allergies
PET positron emission tomography
NKDA no known drug allergies, non-ketotic diabetic acidosis
PFT pulmonary function test
NKMA no known medication allergies
PG prostaglandin
noc night
PH past history
non not
PI present illness
NPD nightly peritoneal dialysis
PICC peripherally inserted central venous catheter
NPO nothing by mouth
PID pelvic inflammatory disease
NS (NIS) normal saline
Pleo more than usual
NSAID nonsteroidal anti-inflammatory drug
PMI point of maximal impulse
NS normal saline
PMH past medical history
NSR normal sinus rhythm
PNH paroxysmal nocturnal hemoglobinuria
NTD neural tube defect
PO by mouth
NV nausea & vomiting
Poly many
NYD not yet diagnosed
Post after, behind, Postoperative (after operation); postpartum (after childbirth);
O2 oxygen postocular (behind eye)
Ob before, against post op post-operative
Octa eight PRBC packed red blood cells
Octo eight Pre before, in front of, Premaxillary (in front of maxilla); preoral (in front of
mouth)
Oligo few

22
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

pre op pre-operative SAST serum aspartate aminotransferase
prep preparation SB spina bifida
PRN as needed SBO small bowel obstruction
Pro before, in front of, Prognosis (foreknowledge); prophase (appear before) Semi half, Semi cartilaginous (half cartilage); semi lunar(half-moon);
semiconscious (half conscious)
pros besides
SGPT serum glutamic-pyruvic transaminase
prox besides
SLE systemic lupus erythematosus
PS pyloric stenosis
SNF skilled nursing facility
PSA prostate specific antigen
SOB shortness of breath
Pseudo false, fake
SOBOE shortness of breath on exertion
PT prothrombin time
SOP standard operating procedure
P.T. physical therapy
SR sinus rhythm
PTT partial thromboplastin time
SS social services
PUD peptic ulcer disease
STAT immediately
PVD peripheral vascular disease
STD sexually transmitted disease
Px pneumothorax
STH somatotropic hormone
Q every
STM short term memory
QD everyday
Sub under, Subcutaneous (under skin); subarachnoid (under arachnoid); (under
QH every hour nail)
Q2H every 2 hours SUI stress urinary incontinence
QID four times a day super above, upper, excessive, Supercilia (upper brows); supernumerary
qns quantity not sufficient (excessive number); supermedial (above middle)
QOD every other day supra above, upper, excessive Suprarenal (above kidney); suprasternal (above
sternum); suprascapular (on upper part of scapula)
Qs quantity sufficient, quantity required
SVR systemic vascular resistance
quar(r) four
sym together, with, Symphysis (growing together); synapsis (joining together);
R respirations synarthrosis (articulation of joints together)
RAD reactive airway disease syn together, with
RAI radioactive iodine sys together, with
RAIU radioactive iodine uptake Sx symptoms
RBC red blood cells T temperature
RDW red cell distribution width T3 triiodothyronine
Re back, again, contrary, Reflex (bend back); revert (turn again to); T4 thyroxine
regurgitation (backward flowing, contrary to normal)
TBSA total body surface area
REEDA redness, edema, ecchymosis, drainage, approximation
TCDB turn, cough, deep breathe
Retro backward, located behind Retrocervical (located behind cervix); retrograde
(going backward); retrolingual. (behind tongue) TDM treadmill
RHD rheumatic heart disease, relative hepatic dullness TED (hose) thrombo-embolism deterrent
RLQ right lower quadrant TEP transesophageal puncture
RM respiratory movement Tetra four
RO rule out Thio sulfur
ROM range of motion THR total hip replacement
ROS review of systems THTM thallium treadmill
RT or R right TIA transient ischemic attack
RUQ right upper quadrant TIBC total iron binding capacity
Rx prescription, pharmacy TID three times a day
S(s) without TIL tumor infiltrating lymphocytes
S/S signs & symptoms TKR total knee replacement
SAB spontaneous abortion TNF tumor necrosis factor

 23
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

TNM tumor, node, metastases WHO World Health Organization

TNTC too numerous to mention WN well nourished
TP tuberculin precipitation WNL within normal limits
TPN total parenteral nutrition X times
TPR temperature, pulse, respiration
Trans across, through, beyond, Transection (cut across); transduodenal (through Anatomy
duodenum); transmit (send beyond)
Anatomy is the science of the structure of the body. This section
TTN transient tachypnea of the newborn will address systemic, regional, and clinical anatomy as it applies
TTP thrombotic thrombocytopenia purpura to coding in the Anesthesia setting. Anatomical terms have
Tri three distinct meanings and are a major part of medical terminology.
TUPR transurethral prostatic resection Anatomical Positions
TURP transurethral resection of the prostate Often in medical records, anatomical positional terms are used
TWB touch weight bear to identify specific areas of body parts and body positions. The
TWE tap water enema
following list is commonly used terms that may be found in
medical documentation:
Tx treatment, traction
• Superior = Nearer to head
UA urinalysis
• Inferior (caudal) = Nearer to feet
UAO upper airway obstruction • Anterior (ventral) = Nearer to front
UBW usual body weight • Proximal = Nearer to trunk or point of origin (e.g., of a
UGA under general anesthesia limb)
UGI upper gastrointestinal
• Distal = Farther from trunk or point of origin (e.g., of a limb)
• Superficial = Nearer to or on surface
Ultra beyond, in excess, Ultraviolet (beyond violet end of spectrum); ultrasonic
(sound waves beyond the upper frequency of hearing by human ear) • Deep = Farther from surface
• Posterior (dorsal) = Nearer to back
Uni one
• Medial = Nearer to median plane
up ad lib up as desired • Lateral = Farther from median plane
UPJ ureteropelvic junction
Anatomical Planes
URI upper respiratory infection Anatomical descriptions are based on four anatomical planes that
US ultrasonic, ultrasound pass through the body in the anatomical position:
USA unstable angina • Median plane (midsagittal plane) is the vertical plane
UTI urinary tract infection passing longitudinally through the body, dividing it into
UVJ ureterovesical junction
right and left halves
• Paramedian (parasagittal) plane is a sagittal plane that
VA visual acuity divides the body into unequal right and left regions.
VBP venous blood pressure • Coronal (frontal) planes are vertical planes passing through
VBAC vaginal birth after caesarean the body at right angles to the median plane, dividing it into
anterior (front) and posterior (back) portions
VC ventricular contraction
• Horizontal planes are transverse planes passing through the
VENT ventral body at right angles to the median and coronal planes; a
VF/Vfib ventricular fibrillation horizontal plane divides the body into superior (upper) and
VLDL very low density lipoprotein
inferior (lower) parts (it is helpful to give a reference point
such as a horizontal plane through the umbilicus).
VP venous pressure, venipuncture
VPB ventricular premature beats
VPC ventricular premature contractions
VS vital signs
VSD ventricular septal defect
VT/Vtach ventricular tachycardia
W vessel wall
W/C wheelchair
WBC white blood cell
WD well developed

24
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

Anatomical Movement Terms
Various terms are used to describe movements of the body.
Movements take place at joints where two or more bones or
cartilages articulate with one another. They are described as pairs
of opposites.
Flexion Bending of a part or decreasing the
angle between body parts.
Extension Straightening a part or increasing the
angle between body parts.
Abduction Moving away from the median plane
of the body in the coronal plane.
Adduction Moving toward the median plane of
the body in the coronal plane. In the
digits (fingers and toes), abduction
means spreading them, and adduction
refers to drawing them together.
Rotation Moving a part of the body around its
long axis. Medial rotation turns the
anterior surface medially and lateral
rotation turns this surface laterally.
Circumduction The circular movement of the limbs,
or parts of them, combining in
sequence the movements of flexion,
extension, abduction, and adduction.
Pronation A medial rotation of the forearm and
hand so that the palm faces posteriorly.
Supination A lateral rotation of the forearm and
hand so that the palm faces anteriorly,
as in the anatomical position.
Eversion Turning sole of foot outward.
Inversion Turning sole of foot inward.
Protrusion (protraction) To move the jaw anteriorly.
Retrusion (retraction) To move the jaw posteriorly.

 25
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

Anatomical Planes

26
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

Anesthesia/Pain Management Anatomy
The illustrations on the following pages detail anatomical images which relate to Anesthesia/Pain Management:

Male Figure
(Anterior View)

Parietal region

Frontal region
Orbital region Temporal region
Nasal region
Oral region
Mental region
Anterior neck region
Lateral neck region
Infraclavicular region
Deltoid region
Sternal region
Pectoral region Axillary region

Brachial region
Hypochondriac region
Cubital region Epigastric region

Umbilical region
Antebrachial region Lateral abdominal region

Inguinal region
Pubic region

Femoral region

Knee region

Crural region

© Fairman Studios, LLC, 2002. All Rights Reserved.

 27
Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

Female Figure
(Anterior View)

Parietal region
Frontal region
Orbital region Temporal region
Nasal region
Oral region
Mental region
Anterior neck region
Lateral neck region
Infraclavicular region
Deltoid region
Sternal region
Pectoral region Axillary region

Brachial region
Hypochondriac region
Epigastric region
Cubital region

Umbilical region
Antebrachial region Lateral abdominal region

Inguinal region
Pubic region

Femoral region

Knee region

Crural region

© Fairman Studios, LLC, 2002. All Rights Reserved.

28
CPT® Coding Essentials for Anesthesia and Pain Management 2019 Terminology, Abbreviations, and Basic Anatomy

Terminology & Abbreviations

Muscular System
(Anterior View)

Frontalis m.
Temporalis m.
Orbicularis oculi m. Zygomaticus minor m.
Zygomaticus major m.
Masseter m. Orbicularis oris m.
Buccinator m. Depressor anguli oris m.
Sternocleidomastoid m.
Levator scapulae m.
Trapezius m.

Deltoid m. Pectoralis minor m.

Pectoralis major m. Internal intercostal mm.
Coracobrachialis m.
Serratus anterior m. Brachialis m.
Biceps brachii m.
Rectus sheath
Brachialis m.
Rectus abdominus m.
External abdominal Linea alba
oblique m.
Brachioradialis m.
Internal abdominal oblique m.
Extensor carpi
Transversus abdominus m.
radialis longus m.
Palmaris longus m.
Palmaris longus m.
Flexor pollicis longus m.
Flexor carpi radialis m.
Superficial inguinal ring Flexor digitorum
superficialis m.
Tensor fasciae
Abductor pollicis
latae m.
brevis m.
Sartorius m. Flexor pollicis
Iliopsoas m.
Adductor longus m. brevis m.
Rectus femoris m. Pectineus m.
Abductor digiti
Vastus lateralis m. Adductor brevis m. minimi m.
Iliotibial tract Adductor magnus m.
Vastus medialis m. Vastus lateralis m.
Gracilis m.
Vastus medialis m.
Lateral patellar retinaculum Patella
Patellar ligament
Tibialis anterior m. Medial patellar retinaculum
Gastrocnemius m.
Peroneus longus m. Tibia
Peroneus brevis m.
Soleus m.
Extensor digitorum longus m.
Flexor digitorum longus m.
Extensor hallucis longus m.

Extensor hallucis brevis m.

Abductor hallucis m.

© Fairman Studios, LLC, 2002. All Rights Reserved.

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Terminology & Abbreviations Terminology, Abbreviations, and Basic Anatomy CPT® Coding Essentials for Anesthesia and Pain Management 2019

Skeletal System
(Vertebral Column – Left Lateral View)

Atlas (C1)
Axis (C2)

Cervical curve Cervical vertebrae (C1-C7)

C7
T1

Intervertebral discs

Thoracic vertebrae (T1-T12)

Thoracic curve

Foveae for ribs

T12

L1

Lumbar curve Lumbar vertebrae (L1-L5)

Intervertebral foramina

L5

Sacrum
Pelvic curve

Coccyx

© Fairman Studios, LLC, 2002. All Rights Reserved.

30
Another random document with
no related content on Scribd:
 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN