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opinions please - I have a patient

  1. #1
    Default opinions please - I have a patient
    Medical Coding Books
    I have a patient that was on the table, anesthesia already induced and patient asleep, TEE probe placed, and A-line started. Surgeon was prepping and got called away for emergency CABG. We took this patient back in later in the day and did her surgery 33641 and 33257. My question is, can the anesthesiologist still get compensated for his time in surgery the first time? As well as the probe placement and the A-line? He was in 1 hour 24 min. Would I use the 00562-53? Unsure about the 53 modifier since it wasn't really cancelled due to our patients health, but because the surgeon got called away for another emergency. The description for 53 modifier does say "due to extenuating circumstances or those that threaten the well being of the patient it may be necesary to indicate that a surgical or diagnostic procedure was started but discontinued."
    I'm thinking I will use the 00562-53, 93313, 36620-59. Any and all thoughts please?
    As always, thanks for all your advice, counseling, and help!

  2. #2
    I don't do a lot of anesthesia coding anymore but our policy was that the anesthesia time can still be billed but you wouldn't use the 53 modifier. That was used by the surgeon or the provider that had started a procedure and didn't finish. The anesthesia provider still provided the anesthesia so you'd bill that with time and if they performed any procedure completely, bill those as well.

    I'd also like to know what anesthesia coders also say...anesthesia coding has been an interest of mine...
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  3. #3
    East Stroudsburg, PA
    Modifier 53 "due to extenuating circumstances OR those that threaten the well being of the patient it may be necesary to indicate that a surgical or diagnostic procedure was started but discontinued."

    Key word is "OR". You can use modfier 53 to represent the discontinued anesthesia service. Dr was called out due to extenuating circumstances.

    If you look at modifiers 73 or 74 they refer you to use 53 for phyisican reporting of discontinued anesthesia services.
    ~Rebecca, CPC, COSC, CPC-I

    "To the world you may be one person, but to one person you may be the world" ~Anonymous

  4. #4

    It would depend on the documentation as to if I would bill both services. If the anesthesiologist "recycled" any part of the anesthesia record (i.e. did not complete a new pre-anesthesia evaluation) then no question I would bill as one service as discontinuous time because my documentation would not support two separate charges. Doing this would allow your provider to be paid for all of his/her full time and only be paid for base units x1.

    If the provider documented separate and complete anesthesia records for each service you can bill for both services separately. Be prepared to provide medical rationale to the insurance and possibly an explanation to the patient. You would need to add the -59 modifier to the lesser service to avoid a denial as a duplicate.

    In regards the the -53 modifier. It has been my experience that payers do not recognize this modifier on anesthesia services and unit/time based charges. Their logic is that the anesthesia was not cancelled, it was the surgical procedure that was cancelled and therefore, this modifier would be reported by the surgeon. I'm located in Nebraska and have found all of my payers follow the non use of -53 on anesthesia charges.

    I would also bill the TEE (was probably repeated for 2nd procedure) and aline (was probably left in place and used during the second surgery) as performed including repeat services as documented.

    Hope this helps.
    Julie, CPC
    Last edited by jdrueppel; 07-29-2009 at 05:57 PM.

  5. #5
    Default opinions
    Thanks to all for your responses. It is much appreciated and gave us plenty of discussion. We're still discussing!!!! Not sure exactly which way we will go, but we'll get there. Thanks again!

  6. Default When the anesthesia is contraindicated ...
    General anesthesia was discontinued after 20 minutes of induction as AR record and note shows was contraindicated and blocks were administered and the procedure continued. Is the 20 minutes of General Anesthesia billable?

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