Anesthesia Coding Alert

Question: If the surgeon discontinues a procedure after anesthesia, is it appropriate to append modifier 74 to the anesthesia code?

Arkansas Subscriber

Answer: Modifier 74 (Discontinued out-patient hospital/ambulatory surgery center [ASC] procedure after administration of anesthesia) is reserved for hospital or ASC outpatient use -- that is, if you are billing for the facility side.

What to do:  If you are coding for the anesthesiologist rather than a facility, you may be able to append modifier 53 (Discontinued procedure) to the anesthesia code.

Note the reason for discontinued procedure: Modifier 53 is reserved for situations when your anesthesiologist sees a risk threatening the patient›s health if the procedure continues. The provider can cancel the procedure at any one of three points:

1. Preoperative visit: Your anesthesiologist completes the standard preoperative visit but believes the patient is not a good candidate for the recommended surgery. He discusses the situation with the surgeon, and the surgeon cancels the case. If the rescheduled date is far enough in the future to merit another complete preop consult (usually at least two or three weeks later), bill the original exam with the appropriate consultation code (99241-99245 for office/outpatient or 99251-99255 for inpatient).

The second consult (when the case actually takes place) is considered part of the anesthesia service at the time of surgery.

Why not 53? In the past, you would report the canceled visit with an E/M service code and modifier 53.

Current CPT^® guidelines, however, state that you don't use modifier 53 "to report the elective cancellation of a procedure prior to a patient's anesthesia induction and/or surgical preparation in the operating suite."

2. Before induction: If before the case begins, your anesthesiologist sees an arrhythmia, for example, when he begins monitoring the patient, the surgeon may cancel the case so she can be evaluated and rescheduled.

3. After induction: If your anesthesiologist induced the patient but saw a sudden drop in blood pressure, for example, he may advise the surgeon the case should not proceed.

Remember: Modifier 53 cannot be appended if the patient elects to cancel the procedure prior to anesthesia induction. Further, modifier 53 should only be reported when requested by specific policy. If the anesthesia service was canceled midway through surgery, payment will be reduced by virtue of a shorter than normal anesthesia time.