Anesthesia Coding Alert

Focus on 2 areas to ensure correct reporting

If your anesthesiologist performs multiple services for a patient on the same day, brush up on some modifier 59 basics to avoid being caught in OIG’s crosshairs. Verify That Procedures Meet Criteria   Appending modifier 59 (Distinct procedural service) to your claim means the anesthesiologist performed more than one service for the patient on the same day. But the services you submit with modifier 59 must be “distinct” from each other.

Physicians can perform services qualifying for modifier 59 during the same session or at different times on the same day. Services you can report modifier 59 for include different procedures, sites, incisions, excisions, lesions or injuries, says Cindy Clark, anesthesia coding supervisor with Anesthesiology Consultants in Savannah, Ga.

Your key from a coding perspective is to show that the services were separate from each other before you append modifier 59.

“Records should document separate times that indicate different sessions,” says Joseph Fisher, CPC, anesthesia coding consultant with Per-Se Technologies in Philadelphia. Your provider must clearly document his time with the patient during both services before you can justify modifier 59, especially if the second service is related to the original procedure.

Example: Your anesthesiologist participates in a patient’s coronary artery bypass graft (CABG) procedure (00562, Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator; or 00566, Anesthesia for direct coronary artery bypass grafting without pump oxygenator).

The procedure lasts from 9 a.m. until noon. The patient returns to the operating room at 1:10 p.m. for chest exploration due to postoperative hemorrhage (00560, Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator).

Appending modifier 59 to the second anesthesia service is appropriate because it indicates that the chest exploration was separate and distinct from the original CABG surgery. Having different start and stop times for each procedure supports your claim that the anesthesiologist performed two distinct services for the patient.
 
Extra help: Fisher recommends sending a copy of each procedure’s anesthesia record when you submit the claims to verify the separate times for each session.

Heads up: Some carriers, such as Empire in New York, allow your physician to use a post-op catheter during the procedure if “such use is only incidental to the general anesthesia. If it is used as the principal method of anesthesia, then it should be included as part of the surgical anesthesia care, and not billed separately.” Train  your physicians to document epidurals thoroughly [...]