Unintended awareness under general anesth during proc, sqla

This code signifies a patient's experience of being conscious or aware during a surgical procedure performed under general anesthesia. It describes the distressing phenomenon where the patient can recall events, feel pain, or perceive their surroundings while expected to be fully unconscious.

Apply this code when documentation clearly indicates a patient's unintended awareness during a procedure under general anesthesia, regardless of whether it was a full recall or a more subtle perception. This includes cases where the patient later reports sensory experiences, pain, or auditory awareness from the intraoperative period.

• Ensure the medical record explicitly documents the patient's report or clinical suspicion of intraoperative awareness.
• This code is for the sequela (after-effect) of the event, not the acute event itself if other codes are more specific for the immediate complication.
• Always look for additional codes to describe any associated psychological or physical sequelae, such as PTSD or anxiety.