Anesthesia Coding Alert

Question: A  patient was given general anesthesia in preparation for an open-heart procedure. Due to an emergency (which had nothing to do with this patient), the patient had to be taken from the operating room to the critical care intensive unit to await another operating room. Eventually, the case was postponed for a later date. Should I bill the procedure with modifier -53 (discontinued procedure)? Should I bill any base units?

Pennsylvania Subscriber
 
 Answer: If an outside emergency, rather than a medical necessity, causes a procedure to be discontinued, check with your Medicare carrier or commercial insurer before submitting a claim. In this instance, it might be preferable not to bill for the discontinued procedure. At the least, serious questions might arise as to why general anesthesia was induced before an operating suite was fully available.
 
When a case is discontinued due to medical necessity, base and time units are billed with modifier -53 for discontinued procedures if the anesthesia was started. This is because the base units include preoperative evaluation, patient prep, and postoperative follow-up, which happens whether or not  the case was discontinued. In other words, the anesthesia team has done what it would normally do had the case continued.
 
Be sure to include a diagnosis that reflects the medically necessary reason for discontinuing the procedure. For example, a patient is undergoing a coronary artery bypass graft x3 (33519, three venous grafts [list separately in addition to code for arterial graft]) and the procedure was discontinued due to cardiac complications. The anesthesiologist would submit 00562-53 (anesthesia for procedures on heart, pericardium, and great vessels of the chest; with pump oxygenator), the amount of time spent, and diagnosis code 997.1 (cardiac complications). If the surgery is completed at a later time, the anesthesiologist would submit 00562 (without the modifier), the amount of time spent, and diagnosis code 411.1 (intermediate coronary syndrome).