Anesthesia Coding Alert

Nugget: Anesthesiologists can use modifier -25 to increase reimbursement in the appropriate situations.

Anesthesia coding experts say that if the physician meets the criteria for the key components of the evaluation and management (E/M) service (history, exam, medical decision-making) in conjunction with the procedure and/or service performed and can document that it was a separate service from others performed on the same day, this circumstance may be reported by adding modifier -25 to the appropriate level of E/M service.

The Health Care Financing Administration (HCFA) published a final rule in the Nov. 2, 1999, edition of the Federal Register that outlined the use of modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Although several months have passed since the ruling went into effect in January 2000, some anesthesia practices still have questions about how this modifier can be used and how it should be documented.

What the Rule Says

According to the rule, it is appropriate to bill modifier -25 when a patients condition requires a significant, separately identifiable evaluation and management (E/M) service above and beyond the usual preoperative and postoperative care associated with the procedure that was performed. E/M service may be prompted by the symptom or condition for which the procedure and/or service was performed.

As such, different diagnoses are not required for reporting the E/M services on the same date a procedure or service was performed. In other words, you may use the same ICD-9 code for both procedural services if it is medically necessary and appropriate, according to Kathy Payne, operations manager with the physician group Anesthesiologists Associated Inc. in Portland, Ore.

However, if it is medically necessary and appropriate to use two different ICD-9 codes , Payne says you should use the two different ICD-9 codes.

Cases When Modifier -25 Can be Billed

Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant in North Augusta, S.C., cites these examples of cases when it is appropriate to use modifier -25 along with the procedure codes:

When an initial patient comes to the office and the anesthesiologist performs and documents an expanded medical history, exam and straightforward medical decision-making (code 99202), and the full workup leads to the decision to initiate a nerve block injection, use code 62311 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substances[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) along with modifier -25.

An established patient comes to the office for his scheduled second injection for pain [...]