Anesthesia Coding Alert

Question: The hospital requested that our anesthesiologist who will be administering anesthesia during surgery also handle the post-CABG and AVR critical care. I filed a claim with 99291 for the 45 minutes he spent with the patient, but it was denied as part of the surgery. Is there a way for us to be paid for the additional care with modifier 24 or other documentation? Or is it part of the global period and non-reimbursable?

West Virginia Subscriber

Answer: Critical care is not bundled with anesthesia code 00566 (Anesthesia for direct coronary artery bypass grafting; without pump oxygenator) or 00567 (… with pump oxygenator). If the payer follows the National Correct Coding Initiative (NCCI) edits, you should be able to appeal with documentation from both services.

Modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) is related to evaluation and management (E/M) services. Therefore, that modifier is inappropriate in the scenario you present.

If you are billing for critical care services administered for a condition unrelated to the primary procedure, you can report the appropriate critical care code (such as 99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) with modifier 24. Remember the service must meet several criteria before qualifying for modifier 24:

• The E/M service occurs during the postoperative period of another procedure.
• The current E/M service is unrelated to the previous procedure.
• The same physician (or tax ID or same group and specialty) who performed the previous procedure provides the E/M.
• The patient’s diagnosis documented must meet medically necessity for the visit.