Anesthesia Coding Alert

Question: A non-medically directed CRNA prepared to provide monitored anesthesia care during a pain case. During the preprocedure workup, the patient complained of nausea, difficulty breathing and faintness. The physician canceled the case (before the CRNA began MAC) and referred the patient for a cardiopulmonary workup. How should I report this case? 

West Virginia Subscriber Answer: Coders often discuss the best " and most fair " way to handle canceled cases. Your group should establish guidelines for the future, but keep these rules of thumb in mind.
 
The procedure location helps determine how you handle the situation. In an ambulatory surgery center, report the appropriate anesthesia code for the case and append modifier 73 (Discontinued outpatient procedure prior to anesthesia administration) or modifier 74 (Discontinued outpatient procedure after anesthesia administration), depending on when the physician canceled the case.
 
In a hospital setting, some coders recommend reporting modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) because the patient will most likely have the procedure at a later date. But if the surgeon reschedules the procedure within the next few days, other coders say you should not charge for your services this time. Wait until the procedure actually takes place and bill for it then. 

 -- Answers to You Be the Coder and Reader Questions were provided by Terry Celestino, CPC, of Tejas Anesthesia in San Antonio.