Wiki Cancelled before induction but after prep

[karenkessell]

I am specifically looking for the Medicare billing guidelines for anesthesia services cancelled before induction but after preparation. I appreciate your help!

 

[LeslieJ]

Found this for you from Florida Blue - it spells it out pretty good, IMHO - with one TEENY exception I'll explain in a minute.

Cancelled Anesthesia
If anesthesia is cancelled due to unforeseen circumstances, the pre-anesthetic exam and the anesthesia services furnished may be billed and paid depending on when the anesthesia services were terminated and whether or not the procedure is rescheduled for a later date.

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  If a case was cancelled after the pre-operative exam but prior to the patient being prepared for surgery or induction, the service may be covered at the E/M level of care rendered (e.g., brief or limited visit) as a hospital or office visit.

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  A pre-anesthesia evaluation by the anesthesiologist when the procedure is delayed less than 30-days is not eligible for coverage as a separate procedure. It is an integral part of the subsequent anesthesia services.

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  If a case was cancelled after induction of anesthesia, bill the case with the anesthesia CPT code for the procedure that was being rendered. Add a “53” for the tertiary modifier to indicate the discontinued procedure. Reimbursement will be based on the amount of time reported plus the base units for the discontinued procedure.

COLOR]

Here's my TEENY exception, based on experience. MOST (not all) payers do not want modifier 53; they will reject the claim. That's because 1 body, 1 service that either starts or stops; it doesn't "discontinue" like a surgery does. I find that adding a V64.1x diagnosis code helps, too. The take-away on this one is that the use of modifier 53 is payer-specific!

Here's the link if someone wants to follow up! http://providermanual.bcbsfl.com/ARS/cr/bg/Pages/Anesthesia-Services.aspx


L J