Anesthesia Coding Alert

Question: I am coding for a Medicare patient who returned to the OR for chest exploration after the he underwent a CABG (coronary artery bypass graft). The second case was done later in the evening and it is hitting an edit against the first case. Is there a modifier I should add to the second claim?

Minnesota Subscriber

Answer: Yes, you should be able to report anesthesia services for both procedures with clear documentation.

If the second procedure is not related to the original CABG procedure, append modifier 59 (Distinct procedural service) or one of the “X” modifiers (XE, XP, or XU) as appropriate to the second case. These are:

• XE (Separate encounter, A service that is distinct because it occurred during a separate encounter)
• XS (Separate structure, A service that is distinct because it was performed on a separate organ/structure)
• XP (Separate practitioner, A service that is distinct because it was performed by a different practitioner)
• XU (Unusual non-overlapping service, The use of a service that is distinct because it does not overlap usual components of the main service).

Although it is rare, some payers may ask you to append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to differentiate the second procedure, but that’s only when the return to surgery is directly related to the original case and is a specific payer requirement.

Also note: Do not use modifiers 76 (Repeat procedure or service by same physician or other qualified health care professional) or 77 (Repeat procedure by another physician or other qualified health care professional) because these describe a situation in which the physician reports the same procedure twice.