Anesthesia Coding Alert

Patient safety is the deciding factor for "Discontinued procedure."

The anesthesiologist or surgeon -- or even the patient -- might determine a procedure should be cancelled. Check out these examples of the three points when the physician might order a cancellation.

Preoperative visit: The anesthesiologist completes the standard preoperative visit but believes the patient is not a good candidate for the recommended surgery. He discusses the situation with the surgeon, and the surgeon cancels the case. If the rescheduled date is far enough in the future to merit another complete pre-op consult (usually at least two or three weeks later), bill the original exam with the appropriate consultation code (99241-99245 for office/outpatient or 99251-99255 for inpatient). The second consult (when the case actually takes place) is part of the anesthesia service at the time of surgery.

Before induction: Mrs. Smith is prepared for surgery. Before the case begins, your anesthesiologist sees an arrhythmia when he begins monitoring her. Her surgeon cancels the case so she can be evaluated and rescheduled. Some carriers, such as Empire New York, recommend that you report the case with 01999 and append modifier 53.

After induction: Your anesthesiologist induces Mr. Jones but sees a sudden drop in blood pressure. He advises the surgeon that the case should not proceed. He reverses the anesthesia, and Mr. Jones transfers to the intensive care unit or other area for stabilization and further tests. You can report either 01999 with modifier 53 again or the appropriate anesthesia code (based on the planned procedure) and modifier 53.