Anesthesia coding with Modifiers


Salina, KS
Best answers
I am fairly new to Anesthesia coding and struggle with the use of modifiers at times. I've been a primary coder for years but this trips me up sometimes. I have a patient that had a normal vaginal delivery and then underwent a tubal. The anesthesia providers were different for each service. The tubal was performed right after the delivery. I used 00851-59 as my code on the tubal portion of the procedure. I received a denial that -59 was the incorrect modifier for this procedure. I get payment ok when the -59 is used and the same provider is in on the delivery and then the tubal. Any advice would be awesome!!! Thank you!!! :eek:
I'd check out the first page of the Anesthesia section in the CPT book as the anesthesia guidelines are there about inclusions and exclusions. In the section for multiple procedures. It says to code the more complex anesthesia code performed during a single anesthesia administration and the time reported should be the combined total for all procedures
Were both services done in the same operative session? Or did the patient come back to the OR later for the tubal? If done in the same session, you would choose the anesthesia CPT with the higher base units and bill for one service. If the patient left OR and came back later for second procedure under a separate anesthetic administration, a separate claim would be billed. In my area, only Medicare payers have required a modifier 59. Are your providers self employed or part of a group? If employed by the same group, the modifier 59 should be sufficient.