Anesthesia Coding Alert

Question: One of my providers administered anesthesia for a screening colonoscopy. The patient was then taken to the OR for a hernia repair performed by a different provider (the same anesthesiologist attended). My understanding is that I should bill the hernia repair and add the time from the colonoscopy to that. My providers are questioning this because the procedures were performed in two different areas. What do you advise?

Michigan Subscriber

Answer: Your providers are correct to question the combination approach. The two procedures (colonoscopy and hernia repair) occurred at different times with different surgeons. Even though the same anesthesiologist was present for both procedures, you should bill them separately.

Submit 00812 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy) for the colonoscopy anesthesia. The correct code for anesthesia during the hernia repair will depend on the specifics of the case (upper or lower abdomen, surgical approach, and patient age). Begin your search with 00750 (Anesthesia for hernia repairs in upper abdomen; not otherwise specified) for a hernia of the upper abdomen and 00830 (Anesthesia for hernia repairs in lower abdomen; not otherwise specified) for a hernia of the lower abdomen. Drill down for more specific codes in either area for the most appropriate.

Append either modifier XP (Separate practitioner…), a service that is distinct because it was performed by a different practitioner) or modifier 59 (Distinct procedural service) to the hernia code and include thorough documentation showing that the procedures were separate. The modifier of choice is XP as it fully explains the situation. However, if your insurance company does not recognize an XP modifier, 59 should be accepted.