Anesthesia Coding Alert

Question: We have a two-surgery claim for a patient, with the payer denying the second procedure. We billed 00942 (Anesthesia for vaginal procedures [including biopsy of labia, vagina, cervix or endometrium]; colpotomy, vaginectomy, colporrhaphy, and open urethral procedures) for the primary procedure. She experienced post-op bleeding and returned to surgery several hours later, for 55 minutes. A different anesthesiologist from our group participated in the second procedure and billed 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). The payer denied the second surgery with the reason "when multiple procedural codes are reported for a single anesthetic administration, only the code with the highest anesthesia base unit will be considered." Are we wrong in thinking that both surgeries should be payable?

California Subscriber

Answer: You need to clarify with the insurance company that you're filing for two separate encounters with separate start and stop times, even though they took place on the same day. Your best option might be to file a paper claim and attach a copy of both anesthesia records as documentation.

Verify modifier: Also check whether the payer's guidelines require a different modifier on the second surgery instead of modifier 78. Some prefer modifier 59 (Distinct procedural service), which clarifies "different encounter" in its full descriptor. Other payers request either modifier 76 (Repeat procedure or service by same physician or other qualified health care professional) or 77 (Repeat procedure or services by another physician or other qualified health care professional) instead of modifier 78.

Many payers have an anesthesia manual on their websites, with instructions on how to bill various claims. If your payer posts this information, stay updated on the changes so you can file correctly.