Anesthesia Coding Alert

Question: A patient with commercial insurance returned to the operating room (for a problem related to the first procedure) less than an hour after the original procedure. If I bill with modifier -78, will the carrier reduce the charges for anesthesia? We planned to charge for anesthesia time only during the second procedure.

Arkansas Subscriber

Answer: Using modifier -78 (return to the operating room for a related procedure during the postoperative period) would be appropriate in this situation, although some coders may suggest that you use modifier -59 (distinct procedural service) instead with an explanation of the situation. Yet another option would be to bill the return with full base and time amounts and no modifier. If you choose this route, however, both charges need to be on the same claim with the actual times of both procedures listed (i.e., 8-9:15 a.m. and 10-11:30 a.m.). The diagnosis for the second trip would need to be changed to reflect a complication.

There is no need for you to reduce your fee. Anesthesia on the patient literally has to be started over again. Even if the patient is still intubated or drowsy, that does not lower the anesthesiologists risk and/or work.


Answers for Reader Questions and You Be the Coder are provided by Vicki Embich, anesthesia coding secretary with West Florida Medical Center Clinic in Pensacola, Fla.