Anesthesia Coding Alert

Question: What guidelines should I follow when a patient returns to the OR later the same day for a second procedure due to complications from the initial one? The same CPT code applies to both procedures, but Medicare won't pay the same CPT for the second procedure because a different CRNA provided the service. Medicare also denies it when we append modifier -78 to the case.

Minnesota Subscriber
 
Answer: Some Medicare carriers do not recognize modifier -78 (Return to the operating room for a related procedure during the postoperative period), but this is not a national policy. Many coders recommend reporting the second service with modifier -59 (Distinct procedural service) instead. Other coders suggest appending modifier -77 (Repeat procedure by another physician) instead.

If your carrier still denies the service, call the appeal line or submit a paper claim with copies of the anesthesia record. Some coders say they are reimbursed after they give the start and stop times of both procedures.

Before coding the procedures separately, verify when the anesthesia provider noted the patient's problem. If it occurred while the patient was en route to the PACU (postanesthesia care unit) or while the provider was in the process of signing the patient to PACU care, do not code separately. Instead, the return to the OR is a continuation of the first case because its anesthesia time has not ended.