Anesthesia Coding Alert

Question: I've been told that I should not usually report modifiers -78  and -59 with anesthesia codes. Why is this? When is it OK to use these modifiers, or what should I use instead?

Indiana Subscriber

Answer: Modifiers -78 (Return to the operating room for a related procedure during the postoperative period) and -59 (Distinct procedural service) don't apply to anesthesia as much as with some specialties, but you can report them under certain circumstances.
 
Modifier -78 is primarily a surgical modifier, but some coders use it when two related procedures are performed on the same day. For example, a patient has a bypass graft, so you code for it with 00563 (Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; with pump oxygenator with hypothermic circulatory arrest). Then the patient has postoperative hemorrhaging later that day and returns to the operating room (OR) so the surgeon can repair the hemorrhage site. You append modifier -78 to the claim for the second procedure (00560, Anesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator).
 
You can use modifier -59 when you report a nerve block placed for postoperative pain management or when a patient returns to the OR the same day. However, since many carriers use modifier -59 in the same way as modifier -51 (Multiple procedures) and reduce the physician's fee, watch the EOBs for processing errors.