Anesthesia Coding Alert

But don’t forget that some insurers will reimburse for higher levels.

Physical status modifiers identify the patient’s health condition, which can affect the level of complexity of anesthesia services. These six levels are included in the Anesthesia guidelines of CPT^®, and are consistent with the American Society of Anesthesiologists’ (ASA) ranking of patient physical status:

• P1 – A normal healthy patient
• P2 – A patient with mild systemic disease
• P3 – A patient with severe systemic disease
• P4 – A patient with severe systemic disease that is a constant threat to life
• P5 – A moribund patient who is not expected to survive without the operation
• P6 – A declared brain-dead patient whose organs are being removed for donor purposes.

Remember: “Traditional Medicare doesn’t pay for physical status modifiers, although some Advantage plans might,” says Kelly D. Dennis, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. “Other private payers allow extra reimbursement for the higher levels, P3 through P5. A trauma center or facility that handles very sick patients should expect a high number of P3 to P5 patients.”

 “Report them whether or not the insurance carrier will recognize and pay for them,” Dennis adds. “If a P modifier is not reported, it will not be paid!”

Final note: Whether you’ll get extra pay for P modifiers or not, it’s still a good idea to include P modifiers on your claims for tracking and documentation purposes.