Anesthesia Coding Alert

Question: How should I code a patient's return to the operating room on the same day? The physician performed a laparoscopic cholecystectomy, then the patient returned to the OR for a craniotomy to repair intracerebral hemorrhage. Which modifier should I report for Medicaid?

West Virginia Subscriber
 
Answer: Coders vary in their advice for this situation, but the carrier will dictate which modifier you report - if you need one at all. Even if two different physicians handled the cases, you should submit separate paper claims with reports. Include a diagnosis that indicates post-operative complications with the second procedure's claim, if appropriate.

Your question is unclear on whether the surgeon performed the second procedure due to a postoperative complication and what type of repair the surgeon performed. If the procedures are unrelated to each other, some coders say you probably don't need a modifier for the second claim because the diagnosis and surgical CPT codes show that you're reporting two different surgeries. (For example, report 997.02 [Iatrogenic cerebrovascular infarction or hemorrhage] if the stroke was a result of the surgery; report 431 [Intracerebral hemorrhage] instead if the bleed was an independent event.)

However, some carriers require modifiers for second procedures even if the surgeries aren't related. If this is the case, append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the second procedure's claim. (You would append modifier -78 [Return to the operating room for a related procedure during the postoperative period] instead if the return to OR was due to a complication of the original surgery.)

Some carriers only accept modifiers -78 and -79 for the surgeon's charges, not for the anesthesiologist's. In these situations, append modifier -59 (Distinct procedural service) to the second procedure's claim if appropriate.
 
Medicaid might not allow two anesthesia services on one day for the same patient. Check your state guidelines or with your provider representative before filing the claim. If this is the case in your state, file for the craniotomy because it represents more allowance, but include the time units for both procedures.