Anesthesia Coding Alert

Question: We have two claims for the same patient on the same date of service, but two different ASA codes were used by two different providers (00740 and 00790). They are on two separate claims, but one is being denied as previously paid for the same day. Are these codes bundled?

North Dakota Subscriber

Answer: When coding for two (or more) separate anesthesia services for the same patient on the same date, let these three scenarios guide your coding.

Scenario 1: If two anesthesia services claims are received for the same patient with the same date of service, the first claim processed will be allowed. The second claim processed is subject to denial if the other provider did not append any medical direction/supervision modifiers. No adjustment for reimbursement to the second anesthesia provider can be made until a corrected claim is received from the first (allowed) anesthesia provider with the missing modifier appended (QK [Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals], QX [CRNA service: with medical direction by a physician], or QY [Medical direction of one certified registered nurse anesthetist {CRNA} by an anesthesiologist]). The billing office for the denied claim is responsible for contacting the billing office for the other anesthesia provider involved (supervised CRNA or the physician providing medical direction) so that arrangements can be made to submit the corrected claim.

Scenario 2: If both the providers are of same specialty and have a common TAX ID, then only one provider can bill for the service performed on the same date, unless special circumstances apply. According to the ASA's RVG, when multiple surgical procedures are performed, only the anesthesia delivery service code with the highest base value is reported. In your situation, 00740 (Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum) has a base unit value of 5 and 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified) has a value of 7. Therefore, if you can only report one code it would be 00790 with the associated time units.

Scenario 3: If the patient had one of the procedures during one anesthetic session and for some reason needed to return to the operating room, for example the patient has post-operative bleeding. The first claim would be filed as normal and the second claim would be filed with a modifier and diagnosis code describing the special circumstances. You should check with payer policy to determine whether a -59 modifier or one of the "X" modifiers would apply to the second claim. In the event an appeal is necessary, make sure both anesthesia records stand alone and show the associated anesthesia times and circumstances.