Anesthesia Coding Alert

Question: I’m new to anesthesia coding and don’t understand when and how to append P modifiers. I’m seeing a lot of denials, both for using them and for not using them. What are the basics I need to know?

New Jersey Subscriber

Answer: P modifiers help the anesthesia provider explain more about the patient’s physical condition during a procedure. You’ll find them in the Anesthesia Guidelines of your CPT^® book:

• P1 – A normal healthy patient 

• P2 – A patient with mild systemic disease 

• P3 – A patient with severe systemic disease 

• P4 – A patient with severe systemic disease that is a constant threat to life 

• P5 – A moribund patient who is not expected to survive without the operation 

• P6 – A declared brain-dead patient whose organs are being removed for donor purposes.

These levels are consistent with the American Society of Anesthesiologists’ ranking of patient physical status. As you can see, the severity of the patient’s condition increases with each modifier.

Guidelines for reporting P modifiers vary by insurer and by geographic location. Traditional Medicare does not recognize P modifiers, although some Medicare Advantage plans may. Coverage by state Medicaid plans can vary, so check with your local payer for verification. Keep these points in mind as you research whether you should include a P modifier on your claim:

Some payers will increase reimbursement for cases that merit higher-level P modifiers because of the extra work involved for the anesthesia provider. You’ll often need to be reporting a status of P3 or higher for additional reimbursement.

• Other payers might allow you to include a P modifier on your claim for documentation purposes, but won’t reimburse for it. 

• Diagnoses that can help support a status of P3 include diabetes, hypertension, COPD, morbid obesity, or chronic heart failure. 

• Diagnoses such as end stage renal disease (ESRD), HIV, hemophilia, lupus, or cancer can help justify a P4status.

If you include a P modifier on the claim, append it to the end of any other modifiers and codes. For example, if your anesthesiologist was present during a salivary gland biopsy for a patient with COPD, you would report AA (Aesthesia services performed personally by anesthesiologist) – 00100 (Anesthesia for procedures on salivary glands, including biopsy) – P3.