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Anesthesia Coding Alert

You Be the Coder:

Know How to Code MAC When a Case Is Cancelled

Published on Wed Jan 01, 2003

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: I know that Medicare allows billing for anesthesia service if a physician cancels a case after induction (using modifier -53, Discontinued procedure). Would this also apply to a monitored anesthesia care (MAC) case when the anesthesia provider administers IV medications for sedation and anesthesia prior to cancellation? If not, how should I bill for the time spent on an unsuccessful attempt at closed reduction? The patient returned later the same day for general anesthesia and a successful reduction.

Virginia Subscriber

 


 
 
 
 
 
 
 
 
 
 

Answer: A case like this leads to many different coding opinions. Some coders might report only time units for the first procedure. Others opt for coding it as a standard anesthesia case (with both base and time units). In my opinion, Medicare's "after-induction" guideline for cancelled cases would generally also apply to MAC cases if the anesthesia provider has already administered sedation. If you use an anesthesia code for the first case, also add modifier -53 (Discontinued procedure) to indicate that the case was canceled.

Append modifier -59 (Distinct procedural service) to the second procedure's code to distinguish it as a separate service. Thoroughly document everything and send copies of both anesthesia reports with the claim to help explain the case.

 


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