Anesthesia Coding Alert

Question: A patient had two different types of anesthesia administered on the same day, but at different times. What modifier should we include on the claim?

New Hampshire Subscriber

Answer: Your best choice is to see if your payer has a published anesthesia policy and check for what modifiers they want for anesthesia. If there’s a published policy, follow its guidance.

If the payer doesn’t have published guidelines, modifier 59 (Distinct procedural service) often is your best option. You’re reporting anesthesia during different encounters, so that meets the initial qualifications for modifier 59. Include a diagnosis code to help explain the situation (such as postoperative bleeding or another complication).

Alternate plan: A few payers might prefer modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) instead of modifier 59.

Some payers, however, don’t want a modifier in these situations. Simply include both anesthesia codes on the claim and a note that the patient underwent two procedures on the same date of service.