Anesthesia Coding Alert

Question: Do you have any recommendations on how to bill a case in which we had two anesthesiologists and two CRNAs all working on one case — placement of a left ventricular assist device in a critically ill non-Medicare patient?

Minnesota Subscriber

Answer: There are a few ways to explain medical necessity and case complexity to the insurance company, including using both modifiers and diagnosis codes that identify the patient’s critical status. For example, you could append the appropriate physical status modifier and modifier XP (Separate Practitioner, a service that is distinct because it was performed by a different practitioner) to identify each provider.

However, there is a chance that the payer may deny the claim, and you will need to appeal the denial. In that case, it would be helpful to have one of the anesthesiologists dictate a cover letter explaining the need for all four providers during the case, specifically, what each of the providers was doing and why all were necessary. Then send the cover letter along with a copy of the anesthesia records and operative report to the payer to help support your case and overturn the denial.