Wiki Anesthesia started then sugery cancelled, how to bill?

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traceystewart

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We are having problems with Medicare when we attach the modifier 74. Our billers are telling us (coders) that Medicare is telling them to leave this modifier off "they don't like it?" We are only using modifier 74 after anesthesia was started but the surgery was cancelled for one reason or another, is this incorrect? Help needed please and thank you all in advance.
Tracey, cpc
 
If you are billing for the facility reimbursement then the 74 is the correct modifier. However this is a facility only modifier. If you are billing for the provider you will use the 53 modifier. You did not say whether you were billing for facility or physician reimbursement so it is difficult to provide an answer.
 
Sorry I didn’t clarify. We are billing for the CRNA provider. We are contracted with the hospital.. So after my reading of your response it gives me a different look at this.. I have just assumed due to procedure being performed at the hospital (facility) that mod 74 was the correct way…but now I’m thinking it isn’t! So per your above post I am thinking that we should use 53 because the CRNA is the anesthesia provider. Is this correct?
Thank you for your great insight. 
Tracey, CPC
 
traceystewart said:
Sorry I didn’t clarify. We are billing for the CRNA provider. We are contracted with the hospital.. So after my reading of your response it gives me a different look at this.. I have just assumed due to procedure being performed at the hospital (facility) that mod 74 was the correct way…but now I’m thinking it isn’t! So per your above post I am thinking that we should use 53 because the CRNA is the anesthesia provider. Is this correct?
Thank you for your great insight. 
Tracey, CPC
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Yes that is correct, use the 53 for pro fee billing. 74 is for facility billing only.
 
Hi,
I have been under the impression for many years that if the anesthesia was started, then the case was cancelled introperatively, you would not append any modifier to the claim.
The anesthesia time is already reflecting the shortened case. I always report the ICD 10 code as the last diagnosis for the contraindication or whatever the situation may be.

If you append the -53 to the case on top of the shortened time, you are reducing your payment by half for no reason. That would result in undercoding!

If the anesthesia was not administered, but the anesthesia professional provided the pre-eval, an E/M code is appropriate.

Please let me know if this thought process is incorrect.

Melissa, CPC
 
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