Anesthesia Coding Alert

  Latest on Physical Status Modifiers (P1-P6) from Codify's Anesthesia Coder  Use Physical Status Modifiers Correctly to Increase Reimbursement Tip: Get Reimbursed for Qualifying P Codes - If the P modifier qualifies for additional reimbursement (meaning the patient is considered to be P3-P5), the payment level depends on which modifier you use. It can also depend on the patient’s insurance carrier Medicare and some other payers do not pay... ...to read the full article and understand the accurate usage of Physical Status Modifiers, subscribe to Codify's Anesthesia Coder.
Take a FREE Trial Today.   "Higher carrier reimbursement for anesthesia procedures requires clarification of the complexity or level of anesthesia beyond the standard reporting codes
(00100 -01999). Understanding and appropriately appending one of six physical status modifiers (P1-P6) that describe a patients condition can determine whether and how much a carrier will reimburse. But coding that is backed up by solid documentation specific, backup information that supports using a higher physical status code will secure the highest payment.

Document, Document, Document

Think about documentation when you start a patients case history says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. He believes that anesthesiologists should always have P documentation whether or not you bill for it. An anesthesia preoperative note must have certain things, including a patients physical status, Groudine explains. I assign all my patients a physical status code, irrespective of insurance or billing concerns, and its in the case notes.

The codes that will bring higher reimbursement are P3 through P5 (P-3, a patient with severe systemic disease; P-4, a patient with severe systemic disease that is a constant threat to life; P-5, a moribund patient who is not expected to survive without the operation). Complicating factors, such as unstable angina, cancer, severe pulmonary disease, previous vascular surgery, or vascular problems, make these patients a higher risk for anesthesia. P1 and P2 patients do not bring higher pay because they are in normal health or have mild systemic disease (such as arthritis, asthma, or noninsulin dependent diabetes) and their anesthesia risk level is relatively low. P6 should not be used because the patient is brain-dead.

As you code, be aware that disparity reigns in carriers policies for higher-level P code payment. To avoid rejection, check first. Some examples: Workers compensation and no-fault insurance carriers in New York state pay for physical status modifiers. Medicare and some other carriers do not. Medicaid carriers in California, Virginia, and some other states dont reimburse for higher physical status codes. And, Meridian, a major carrier in the Midwest and West, refuses reimbursement of additional money for physical [...]