Anesthesia Coding Alert

Question: Our physician provided anesthesia for periprosthetic capsulectomy of the breast. Should I append modifier -50 (Bilateral procedure) to the anesthesia code since it was a bilateral procedure? The surgeon also performed posterior colporrhaphy during the same session. Should I report this with modifier -59 (Distinct procedural service)?

New Hampshire Subscriber

Answer: When the anesthesiologist participates in multiple-procedure cases, you report the procedure code with the highest base value. In this case, code the periprosthetic capsulectomy (19371, Periprosthetic capsulectomy, breast) because it is a higher-base procedure than posterior colporrhaphy (57250, Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy).
 
Even though the surgeon completed a bilateral procedure, you do not report modifier -50 because your physician provided anesthesia. You don't administer anesthesia bilaterally, which means modifier -50 never applies to anesthesia services (but you can report modifier  -50 in conjunction with some pain management services such as bilateral injections). Although you only report one procedure code, you do get credit for the entire session's time; bill 19371 with the total time of both procedures. Also check whether the carrier requires modifier -51 (Multiple procedures) if the physician completes more than one procedure.