Anesthesia Coding Alert

Question: Our anesthesiologist was scheduled to place a Port-a-Cath for a lung cancer patient. The patient went into cardiac arrest before the physician could place the Port-a-Cath, and the anesthesiologist resuscitated her. The anesthesiologist then placed an arterial line, and the surgeon inserted a CVP (central venous catheter). How should we code this? Would appending modifier -59 (Distinct procedural service) be appropriate? Nevada Subscriber Answer: If the patient went into cardiac arrest before the anesthesiologist placed the Port-a-Cath, the cardiopulmonary resuscitation (CPR) is part of the anesthesia care. The physician discontinued the procedure for medical reasons, so you should append modifier -53 (Discontinued procedure) to the code for Port-a-Cath placement (36533,Insertion of implantable venous access device, with or without subcutaneous reservoir; anesthesia code 00532, Anesthesia for access to central venous circulation) after the patient is transferred to the PACU or ICU and is no longer in the anesthesiologist's care. An anesthesiologist can bill for arterial line, CVPand Swan-Ganz catheter insertions, so you can report the A-line for the Port-a-Cath placement as a surgical service.