Sandy,
Per CMS guidelines (Back to the Chapter 2 attachment noted on my previous response) - when procedure is cancelled before induction it is appropriate to bill an E&M. This could even be a consultation if your documentation supports it. We typically bill an inpatient or outpatient E&M as documentation doesn't meet the "request" for consult guidelines because the surgeon's order for anesthesia (or be seen by anesthesia) is a
standing order versus a true request for consultation.
Interestingly, we have just recently started experiencing payment problems from ONLY Medicare and Medicaid, and only for our CRNA E&Ms for cancelled cases. In the state of Nebraska our CRNAs can personally perform services. We changed Medicare carriers to WPS in March an are still in the process of educating them
I'm confident that eventually Medicare and Medicaid will pay. All other carriers pay our E&M charges for cancelled cases.
In regards to the -53 modifier - I have been told and this information was re-interated during an audit (we hire a company to audit us every year for compliance) that this modifier is not appropriate on a multiple unit based fee so we don't use it on any of our anesthesia services. That's not to say it's never appropriate as we all know, many payers make up their own rules. I do, however, use if on our surgical fees (for example - a discontinued central line placement).
Regarding getting reimbursed for OR Room - I'm assuming you're talking about the "time" your provider spent in the OR before case was cancelled. If there is significant time and you meet the guidelines you could bill prolonged attendance in addition the the core E&M code. I don't have my CPT book with me so I can't quote the exact codes for prolonged attendance.
When I get to talking about coding and anesthesia I get a little exited and alot windy - so I'm sorry if this is too much info.
Julie