Anesthesia Coding Alert

Question: A patient went to the OR for a C-section due to bowel obstruction. Can we bill for both the C-section and the bowel repair? Same incision. The C-section of course has a cap reimbursement amount. The bowel procedure added an hour and a half to the op session. Initially it was billed as separate procedures with a 79 on the bowel repair. We have several payors that insist we use such modifiers as 78 and 79 even though they’re not anesthesia appropriate modifiers. We were paid for C-section but denied for the bowel repair because of the modifier. I’m thinking the higher procedure should have been billed for the entire time, but with what modifier? Fellow coders suggested 22. There was also a TAP block done for post-op pain. Any ideas? 

South Carolina Subscriber

Answer: You are correct in your thinking! You can pick the highest-based procedure with the total amount of time for both procedures. Since the C-section has a capped amount, you will need to do the math to determine which of the two codes you should report. No additional modifier is needed to explain the separate procedure as only one code will be reported, with all associated time.

If documentation supports the TAP (transverse abdominus plane) block was performed for post-op pain at the request of the surgeon, you will report the appropriate code — see 64486 (Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)) and 64488 (… by injections (includes imaging guidance, when performed)) — with a modifier to differentiate the block from the anesthetic for the surgery. Although the Correct Coding Initiative (CCI) suggests using the 59 modifier (Distinct procedural service), you can alternatively report an XP (Separate practitioner, a service that is distinct because it was performed by a different practitioner), XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service), or XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) modifier as applicable to your situation.