Anesthesia Coding Alert

Question: Why do we need to use P modifiers even when we don’t get paid extra for the designation?

Illinois Subscriber

Answer: There is always the risk of adverse reaction when a patient needs anesthesia. The P (physical status) modifiers indicate the patient’s physical status pre-anesthesia, which paints a better picture of the overall encounter. Your choices are as follows:

• Modifiers P1 (A normal healthy patient) and P2 (A patient with mild systemic disease) indicate minimal to no risk to the patient during the surgery. Generally, most people under the age of 30 will fall into this category.
• Modifiers P3 (A patient with severe systemic disease) and P4 (A patient with severe systemic disease that is a constant threat to life) indicate a moderate to constant threat to a patient’s life when undergoing surgery.
• Modifier P5 (A moribund patient who is not expected to survive without the operation) is for patients who are pretty sickly. The surgery could life saving or life threatening, but without the surgery, the patient will surely die.
• Modifier P6 (A declared brain-dead patient whose organs are being removed for donor purposes) indicates a patient who is brain dead but the body is still alive. You’ll typically use P6 for a patient who is receiving anesthesia to harvest organs before the provider removes life support.

Though some payers — including traditional Medicare — will not pay anything extra for P modifiers, payers might require the modifiers to prove medical necessity for other anesthesia services in certain situations. The patient’s physical status must be documented in the patient’s medical record, regardless of whether you’ll be reimbursed for it. If you are not sure whether the modifier is paid separately, you should include the appropriate P modifier on the claim.