1 Supplemental Digital Content 1
Supplementary Table 1: Procedure Modifiers
Procedure Modifier Description
AA Anesthesia services performed personally by the anesthesiologist AD Medical supervision by a physician; more than 4 concurrent anesthesia
procedures
G8 Monitored anesthesia care for deep complex complicated, or markedly invasive surgical procedures
G9 Monitored anesthesia care for patient who has a history of severe cardio- pulmonary condition
GC Resident under the direction of a teaching physician
QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS Monitored anesthesia care service
QX CRNA service with medical direction by a physician
QY Medical direction of one certified registered nurse anesthetist by an anesthesiologist
QZ CRNA service without medical direction by physician
*Procedure Modifiers defined by Centers of Medicare and Medicaid Services (CMS)
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
2 Supplementary Table 2: Delivery Model by Procedure Modifier
Delivery Model Primary Procedure
Modifier Additional Modifiers Most Frequent Combined Modifier
Anesthesiologist only AA G8; G9 QS AA (99%)
Medical direction 1:1 QY QX G8; G9 QS G8; G9 QS QXQY (84%)
CRNA only QZ G8; G9 QS QZ (98%)
Medical direction 1:2-4 QK QS; GC QKQX (81%)
QX QS; GC
Supervision 1:>4 AD G8; G9 QS
ADQX (81%)
QX ADG9
QK ADQS
Teaching Resident GC AA; QK; QY; QZ; QX AAGC (91%)
3 Supplementary Table 3: Complication Categorization
ICD-10 diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia-related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
O ver do se of An es th eti cs
Inhaled anesthetics T410X1A, T410X2A, T410X3A,
T410X4A 9682
Poisoning by other gaseous anesthetics Intravenous
anesthetics T411X1A, T411X2A, T411X3A,
T411X4A 9683
Poisoning by intravenous anesthetics Other and
unspecified general anesthetics
T41201A, T41202A, T41203A, T41204A, T41291A, T41292A, T41293A, T41294A
9684
Poisoning by other and unspecified general anesthetics
Local anesthetics T413X1A, T413X2A, T413X3A,
T413X4A 9685
Surface (topical) and infiltration anesthetics Local anesthetics T413X1A, T413X2A, T413X3A,
T413X4A 9689 Poisoning by other and unspecified local
anesthetics Unspecified
anesthetics T4141XA, T4142XA, T4143XA,
T4144XA 9689
Inhaled anesthetics T410X5A 99522 Unspecified adverse effect of anesthesia Intravenous
anesthetics T411X5A 99522
Unspecified adverse effect of anesthesia Other and
unspecified general anesthetics
T41205A, T41295A 99522
Unspecified adverse effect of anesthesia Local anesthetics T413X5A 99522 Unspecified adverse effect of anesthesia Unspecified
anesthetics T4145XA 99522
Unspecified adverse effect of anesthesia Local anesthetics T413X1A E8552 Accidental poisoning by local anesthetics
4 ICD-10
diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia-related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
O ver do se of An es th eti cs
Inhaled
anesthetics T410X5A, T410X5S E9382 Other gaseous anesthetics causing adverse effects in therapeutic use
Intravenous
anesthetics T411X5A, T410X5A E9383 Intravenous anesthetics causing adverse effects in therapeutic use
Other and unspecified general anesthetics
T41205A, T41205S, T41295A,
T41295S E9384
Other and unspecified general anesthetics causing adverse effects in therapeutic use
Local
anesthetics T413X5A, T413X5S E9389 Other and unspecified local anesthetics causing adverse effects in therapeutic use
Unspecified
anesthetics T4145XA, T4145XS E9389 Other and unspecified local anesthetics causing adverse effects in therapeutic use
Inhaled
anesthetics T410X1S,T410X2S,T410X3S,T410X4S 9090 Late effect of poisoning due to drug, medicinal or biological substance
Intravenous
anesthetics T411X1S, T411X2S, T411X3S,
T411X4S 9090 Late effect of poisoning due to drug, medicinal or biological substance
Other and unspecified general anesthetics
T41201S, T41291S, T41292S,
T41293S, T41294S 9090
Late effect of poisoning due to drug, medicinal or biological substance
Local
anesthetics T413X1S,T413X2S,T413X3S,T413X4S 9090 Late effect of poisoning due to drug, medicinal or biological substance
Unspecified
anesthetics T4141XS,T4142XS,T4143XS,T4144XS 9090 Late effect of poisoning due to drug, medicinal or biological substance
5 ICD-10
diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia-related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
O ver do se o f A nes thet ic s
Inhaled anesthetics T410X5S 9095Late effect of adverse effect of drug, medicinal or biological substance
Intravenous
anesthetics T411X5S 9095
Late effect of adverse effect of drug, medicinal or biological substance
Other and unspecified general anesthetics
T41205S,T41295S 9095
Late effect of adverse effect of drug, medicinal or biological substance
Local
anesthetics T413X5S 9095
Late effect of adverse effect of drug, medicinal or biological substance
Unspecified
anesthetics T4145XS 9095
Late effect of adverse effect of drug, medicinal or biological substance
6 ICD-10
diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia- related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
La bo r De live ry o r Pu er pe riu m
Aspiration
pneumonitis O740 66801 Pulmonary complications of anesthesia or other sedation in labor and delivery, delivered, with or without mention of antepartum condition Other pulmonary
complications O741 66801 Pulmonary complications of anesthesia or other sedation in labor and delivery, delivered, with or without mention of antepartum condition Aspiration
pneumonitis O740 66802 Pulmonary complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication
Other pulmonary
complications O741 66802 Pulmonary complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication
Pulmonary
complications O8909 66802 Pulmonary complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication
Pulmonary
complications O8901, O8909 66804 Pulmonary complications of anesthesia or other sedation in labor and delivery, postpartum condition or complication
Cardiac
complications O742 66811 Cardiac complications of anesthesia or other sedation in labor and delivery, delivered, with or without mention of antepartum condition
Cardiac
complications O742 66812 Cardiac complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication
Cardiac
complications O891 66814 Cardiac complications of anesthesia or other sedation in labor and delivery, postpartum condition or complication
Central nervous system
complications
O743 66821
Central nervous system complications of anesthesia or other sedation in labor and delivery, delivered, with or without mention of antepartum condition
7 ICD-10
diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia- related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
La bo r De live ry o r P ue rpe rium
Central nervous system
complications
O743 66822 Central nervous system complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication
Central nervous system
complications
O892 66824 Central nervous system complications of anesthesia or other sedation in labor and delivery, postpartum condition or complication
Toxic reaction to
local anesthesia O744 66881 Other complications of anesthesia or other sedation in labor and delivery, delivered, with or without mention of antepartum condition
Toxic reaction to
local anesthesia O744 66882 Other complications of anesthesia or other sedation in labor and delivery, delivered, with mention of postpartum complication Toxic reaction to
local anesthesia O893 66884 Other complications of anesthesia or other sedation in labor and delivery, postpartum condition or complication
Unspecified
complications O749 66891 Unspecified complication of anesthesia and other sedation in labor and delivery, delivered, with or without mention of antepartum condition
Unspecified
complications O749 66892 Unspecified complication of anesthesia and other sedation in labor and delivery, delivered, with mention of postpartum complication Unspecified
complications O899 66892 Unspecified complication of anesthesia and other sedation in labor and delivery, delivered, with mention of postpartum complication Unspecified
complications O899 66894 Unspecified complication of anesthesia and other sedation in labor and delivery, delivered, with mention of postpartum complication
8 ICD-10
diagnosis codes category from Li
ICD-10 diagnosis codes description from Li
ICD-10 diagnosis codes to identify anesthesia-
related complications from Li
ICD-9 diagnosis
codes Description of ICD-9 diagnosis codes
O th er C om pl icat io ns o f An es th es ia
Other complications of anesthesia,
Hypothermia following anesthesia T8851XA 99589 Other specified adverse effects, not elsewhere classified
Other complications of anesthesia,
Hypothermia following anesthesia T8859XA 99522
Unspecified adverse effect of anesthesia Shock due to anesthesia in which
the correct substance was properly administered
T882XXA 9954
Shock due to anesthesia, not elsewhere classified
Malignant hyperthermia T883XXA 99586 Malignant hyperthermia
Endotracheal tube wrongly placed Y653 E8763 Endotracheal tube wrongly placed during anesthetic procedure
Other complications of anesthesia,
Hypothermia following anesthesia T8852XA 99524 Failed moderate sedation during procedure
Shock due to anesthesia in which the correct substance was properly administered
T882XXS 9093
Late effect of complications of surgical and medical care
Malignant hyperthermia T883XXS 9093 Late effect of complications of surgical and medical care
Failed or difficult intubation T884XXS 9093 Late effect of complications of surgical and medical care
Other complications of anesthesia,
Hypothermia following anesthesia T8851XS,T8852XS,T8859XS 9093 Late effect of complications of surgical and medical care
Failed or difficult intubation T884XXA 9999 Other and unspecified complications of medical care, not elsewhere classified
9 Supplementary Table 4: Complication Type by Year
Complication Type 2011 2012
Overdose of Anesthetics 1,228 1,352 Labor Delivery or Puerperium 1,996 1,969 Other Complications of
Anesthesia 6,801 4,493
Total 10,025 7,814
10 Supplementary Table 5: Patient Safety Indicators (PSI) Complications
PSI Type ICD-9 diagnosis codes Description of ICD-9 diagnosis codes
PS I a dve rs e e ve nt
E8763 Endotracheal tube wrongly placed during
anesthetic procedure
E9381 Halothane causing adverse effects in therapeutic
use
E9382 Other gaseous anesthetics causing adverse effects
in therapeutic use
E9383 Intravenous anesthetics causing adverse effects in therapeutic use
E9384 Other and unspecified general anesthetics causing adverse effects in therapeutic use
E9385 Surface and infiltration anesthetics causing adverse effects in therapeutic use
E9386 Peripheral nerve- and plexus-blocking anesthetics causing adverse effects in therapeutic use
E9387 Spinal anesthetics causing adverse effects in
therapeutic use
E9389 Other and unspecified local anesthetics causing
adverse effects in therapeutic use
PS I po iso ni ng
9681 Poisoning by halothane9682
Poisoning by other gaseous anesthetics 9683
Poisoning by intravenous anesthetics
9684 Poisoning by other and unspecified general
anesthetics
