Anesthesia Coding Alert

Documentation paves the way for discontinued, reduced claims success  

 Seeing an incomplete procedure on a chart can be frustrating, but it doesn’t have to equal zero reimbursement. Master modifiers 52 (Reduced services) and 53 (Discontinued procedure), and you can reap the rewards.

 Many coders get confused between modifiers 52 and 53. But the difference doesn’t have to stump you, according to Carol Pohlig, a senior coding and education specialist with the University of Pennsylvania in Philadelphia.

52 Means Less Than Expected 

 Rely on modifier 52 for an “elective” situation. In other words, your physician chooses not to go any further with the procedure because the procedure has already achieved its objective, Pohlig says. The physician might also end the procedure because she has gathered all the needed information -- there’s no medical reason to not continue with the procedure, but there’s also no medical reason to continue.

 Example: A CPT code calls for a procedure to be performed over a 24-hour period, but the physician only spends 12 hours on it, says Dianne Wilkinson, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, Tenn. You can also report modifier 52 when your physician’s documentation shows that she didn’t complete all the work a code represents.

 Warning: Pohlig cautions against modifier 52 when your physician performs cases that don’t have individual CPT codes. Some coders might be tempted to append modifier 52 to an existing code if the procedure is similar to a portion of an existing procedure code. But CPT rules require you to report an unlisted-procedure code instead, such as 01999 (Unlisted anesthesia procedure[s]) or 64999 (Unlisted procedure, nervous system).

53 Often Represents Patient Safety 

 Modifier 53 (Discontinued procedure) is for situations when the anesthesiologist or surgeon sees some risk that could threaten the patient’s health if the procedure continues. The provider can cancel the procedure at any one of three points: 

 1. Preoperative visit: Your 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.

 Why not 53? In the [...]