Anesthesia Coding Alert

Question: Can you recommend a modifier to report to Florida Medicare for a case where the surgeon submitted a charge for a central venous catheter (CVC)? Documentation indicates the surgeon placed a line on the right side of the neck and our anesthesi­ologist placed a line on the left side.

I’ve tried modifier 59 twice, and it was denied both times. The stated reason for our claims’ denial is service furnished by another provider.

Florida Subscriber

Answer: There are other modifiers you can use to better explain the service. Medicare Administrative Contractor First Coast Service Options, Inc. considers modifier 59 (Distinct procedural service) as a modifier of last resort and instructs you to report the X{EPSU} modifiers to provide greater specificity in situations where modifier 59 was previously reported.

Do this: Use modifier XP (Separate practitioner, a service that is distinct because it was performed by a different practitioner) as the primary modifier to identify your anesthesiologist as a separate practitioner and report modifier LT (Left side) as the secondary modifier to identify the central line placement on the left side.

When submitting your appeal, be sure to include documentation to support the fact that two different providers placed central lines on two different sides of the neck.

First Coast offers this resource to assist coders.