Anesthesia Coding Alert

Question: A patient returned to the operating room (OR) later the same day of surgery because of post-op bleeding after a small bowel resection with lysis of adhesions. The surgeon performed a splenectomy during the second session. The same anesthesiologist was present for both surgeries. What modifier and documentation should I include with the claim?

Texas Subscriber

Answer: Submit 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified) and a diagnosis for the postoperative bleeding, such as 998.1x (Hemorrhage or hematoma or seroma complicating a procedure). Coders vary in their advice on whether to include a modifier for the procedure:

• Modifier 59 (Distinct procedural service) identifies procedures that are not normally reported together but were performed on a different body site or during a different procedure or surgical session, required a separate incision, were related to separate injuries, or were performed during different sessions or encounters.
• Modifier 78 (Unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period) is often viewed as a surgical modifier, but some payers prefer its use. For example, Medica in Minnesota will reimburse separately for multiple anesthesia services provided on the same date of service for separate anesthesia encounters; the policy directs you to append modifier 78 to the code for the second anesthesia encounter.

First step: Talk through the case with your anesthesiologist to verify the details. Then check with the payer in question to determine whether modifier 59 or 78 is appropriate.