Anesthesia Coding Alert

Question: We billed 00140 with modifiers QS, LT, and 3.5 units. Medicare said the modifier is inconsistent, or that we’re missing a modifier. This was for anesthesia during eye surgery (15823) with modifiers LT, RT, and SG. Why did Medicare deny the anesthesia claim?

South Carolina Subscriber

Answer: The surgical code was 15823 (Blepharoplasty, upper eyelid; with excessive skin weighting down lid) and you reported 00140 (Anesthesia for procedures on eye; not otherwise specified) for the anesthesia code. When you look at the ASA Crosswalk, it lists the correct anesthesia code for 15823 as 00103 (Anesthesia for reconstructive procedures of eyelid [e.g., blepharoplasty, ptosis surgery]), not 00140.

Modifiers: Modifier QS represents monitored anesthesia care. Some payers accept this, but others don’t — verify this with your payer. Modifiers LT (Left side) and RT (Right side) should also be acceptable if the procedure was performed on only one eye. The surgery was on both of the patient’s eyes, but your anesthesia claim only noted the left (with modifier LT). You actually don’t need to include modifiers describing which eyes were treated (LT, Left side or RT, Right side). since you’re reporting anesthesia instead of the surgical service. Instead, include the modifier denoting which anesthesia provider was involved in the case (such as AA, Anesthesia service performed personally by anesthesiologist).

Location: You also mention modifier SG, which denotes Ambulatory Surgery Center. Code 15823 is a payable service in an ASC, so the place of service shouldn’t complicate the surgical or anesthesia reimbursement if that’s where the surgery took place.

Final answer: Resubmit the claim for anesthesia services by reporting 00103, modifier QS, and the appropriate anesthesia provider modifier. If the surgery took place in an ASC, include modifier SG.