Anesthesia Coding Alert

You Be the Coder:

Choose Modifiers Carefully for Correct Coding of Consecutive Cases

Published on Mon Jul 10, 2023

Question: A 27-year-old patient who was 40 weeks pregnant presented to the ER and, on examination, was found to be contracting every six minutes with discomfort during the contractions. She was transferred to a delivery room, and anesthesia was called to place a labor epidural catheter for a full-term, uncomplicated delivery. The epidural was placed by the anesthesiologist at 12:21 a.m., and a baby girl was delivered at 3:21 a.m. The doctor personally performed the anesthesia services.

The surgeon was called away to another delivery and returned to perform a tubal ligation for elective sterilization with the anesthesiologist and a CRNA from 7:21 a.m. to 8:36 a.m. During this time, the anesthesiologist was overseeing three cases.

The patient has UnitedHealthcare insurance. How do you report the services provided to this patient, including time and modifiers?

AAPC Forum Participant

Answer: You’ll find UnitedHealthcare addresses this scenario in its anesthesia policy. The anesthesiologist should report the following for their services:

For the epidural, use 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery …) and append modifier AA (Anesthesia services performed personally by anesthesiologist) because the anesthesiologist performed the epidural and oversaw the case.

Diagnosis code 1: O80 (Encounter for full-term uncomplicated delivery)

Anesthesia time 1: Total time was three hours, or 180 minutes, as the epidural was at 12:21 a.m., and the baby was delivered at 3:21 a.m.

For the tubal ligation, report 00851 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/ transection) and append:

modifier QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals);
modifier QX (Crna service: with medical direction by a physician); and
modifier XE (Separate encounter, a service that is distinct because it occurred during a separate encounter).

According to UnitedHealthcare, the second encounter is separate from the initial encounter, and you’d use modifier XE to indicate this to the payer.

Diagnosis code 2: Z30.2 (Encounter for sterilization)

Anesthesia time 2: Total time was one hour and 15 minutes, or 75 minutes, as the tubal ligation started at 7:21 a.m. and ended at 8:36 a.m.