# Two anesthesiologist working together



## FractalMind (Jun 24, 2009)

Hi, we have a case where 2 anesthesiologists are working on the same patient at the same time for a "ruptured femoral aneurysm repair" both doctors belong to the same anesthesia group, one worked for a shorter period of time, we appended mod. 66 that was denied by Mcre because this is a surgeons' mod., does anyone know which modifier would work in this case?

Thanks!
Erika.


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## jdrueppel (Jun 24, 2009)

When I have a medically necessary, appropriately documented two anesthesia provider case I bill the 2nd provider's charge with the -59 modifier and with a short reason and "documentation available" on the electronic claim.  If the payer accepts paper claims I file the claim paper with medical rationale.

Julie, CPC


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## FractalMind (Jun 25, 2009)

have you get paid w/mod. 59? isn't it for "distinct" procedures? or is the 2nd anesthesiologist considered to be "distinct" service because of the medical necessity? I found info. on Mcre part B for a similiar situation (CRNA & anesthesiologist) and they allow both services payment in full, also I got a printout from a workshop that reads we should downcode to 5 units for the 2nd anesthesiologist (which doesn't seem right) but if you have any documentation you could facilitate to me, I would so much appreciate it.

Thanks!
Erika.


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## jdrueppel (Jun 25, 2009)

We consider the second anesthesia provider's services separate and distinct.  We don't have many two MDA provider cases but I can't think of a time when we have not been paid.  Of course we had to be persistent.

For years the ASA Relative Value Guide instructed the 2nd provider's case to be billed at five base units, however, in 2007 they removed that language and it become "by special report."  Our group discussed it and elected to continue with the five base unit value for the 2nd provider.  

You can find the ASA two MDA case billing guideline on page xiii in the 2009 ASA Relative Value Guide.  Let me know if you would like me to fax you a copy.

Julie, CPC


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## FractalMind (Jun 25, 2009)

Thanks Julie! I have the 2009 ASA RVG & can show this info. to my supervisor, I really appreciate your support!!

Erika. (sorry I don't know yet how to insert a happy face from here hahaha)


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