Anesthesia Coding Alert

Reader Questions:

Avoid Using Modifier 47 for Your Anesthesiologist’s Services

Published on Tue May 09, 2023

Question: I am new to anesthesia and have been going through case examples of instances in which additional anesthesia billing is appropriate, including placement of a Swan-Ganz catheter (SGC). I read that when a physician administers the anesthesia, we should bill the procedure code with a -47 modifier. This is confusing, and now I’m unsure if I’m billing SGC placement correctly. Should I be billing the Swan-Ganz code (93503) with a -47 modifier, or have I been billing correctly without it?

Missouri Subscriber

Answer: You are right. Most line placements are included in the scope of service represented by anesthesia CPT® codes. A few exceptions exist, however, which means you can report certain procedures as stand-alone services in most instances. One of those exceptions is the placement of a Swan-Ganz catheter (93503 (Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes)).

You should only append modifier 47 (Anesthesia by surgeon) to a procedure when the surgeon who performs the procedure also administers the regional or general anesthesia. When an anesthesiologist places an SGC, for example, before a cardiac case, you would not use the surgical modifier even though they are performing the catheterization because they are not the surgeon for the actual operation.

Do your homework before taking guidance from online examples, as it might not be applicable or from an authoritative source. Make sure the information you’re considering applies to your specific coding scenario. Also, check whether there are state rules or requirements that might apply to your case. Before sending the claim, verify your individual payer’s requirements, as some may want you to include a special modifier(s) for certain procedures. These details should be outlined in their policy.

Tip: One of the best ways to determine whether modifiers are required is to watch your denials, or if you are in a different department, ask if there is a payment issue with 93503.