Anesthesia Coding Alert

Question: A patient returned to the operating room because of postoperative bleeding after coronary artery bypass (CABG) surgery. We appended modifier 78 to the procedure code and submitted the anesthesia record and operative report with the claim, but Medicare denied it. How should I report this follow-up procedure?

Arizona Subscriber

Answer: Carriers usually consider modifier 78 (Return to the operating room for a related procedure during the postoperative period) a surgical modifier, which means they often deny it for anesthesia claims. Coders recommend different options for submitting the claim, depending on the case circumstances:

• If the patient returned to surgery the same day because of the original procedure, append modifier 76 (Repeat procedure by same physician) to the second procedure's code.

• If the patient returned to surgery the same day for a reason unrelated to the original procedure, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period).
 
• Append modifier 59 (Distinct procedural service) to the anesthesia code.

• Code the second case as a stand-alone procedure without a modifier. Talk with your Medicare representative before resubmitting the claim. With so many options accepted by various carriers, you will want to file the claim according to your carrier's guidelines and include any supporting documentation it requires.