Anesthesia Coding Alert

Question: We are billing for a certified registered nurse anesthetist (CRNA) provider contracted with a local hospital. We billed Medicare using modifier 74 after our provider started the anesthesia but the surgeon cancelled the surgery.  Medicare is telling us to leave the modifier off. Is this correct? Should we be using modifier 53?

AAPC Forum Participant

Answer: In fact, you don’t need to use modifier 74 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia) or modifier 53 (Discontinued procedure) at all. That’s because the surgery was cancelled intraoperatively. In cases like this, you would simply bill for the anesthesia service on its own, as the service was administered even though it did not last as long as it would have had the surgery run its course. If you appended modifier 53, in this situation, not only would you be undercoding, but you could reduce your payment by half!

Remember modifier 74 would be appropriate if you were billing for the ASC and the anesthesia service had begun; if you were billing for the ASC and the surgeon cancelled the surgery before the anesthesia professional administered the anesthesia service, you would use modifier 73 (Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia).

Remember, too, that if the anesthesia was not administered in such a scenario, but the anesthesia professional provided the pre-evaluation, it may be appropriate for you to code for the canceled service using an appropriate evaluation and management (E/M) service, if surgery was not rescheduled within 48 hours, according to the American Society of Anesthesia (ASA).

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC