Anesthesia Coding Alert

Question: Our CRNA administered anesthesia on the same patient on the same day, with a gap in between of 3 hours. We billed the second anesthesia service with 00300 and modifiers QZ and 76. The payer denied the claim as incorrect modifier used. How should we bill the second anesthesia service?

Louisiana Subscriber

Answer: Technically, you’re coding for separate encounters instead of a repeated anesthesia service, unless the patient underwent the same procedure during both encounters. Modifier 76 (Repeat procedure or service by the same physician or other qualified health care professional during the postoperative period) only applies to repeat procedures. If the payer doesn’t agree that you’re reporting a repeat procedure, that would explain the denial and reason for it.

Option: Modifier 59 (Distinct procedural service) might be a better choice to report with modifier QZ (CRNA service: without medical direction by a physician) if the payer denies modifier 76. Also include the associated diagnosis code for the return encounter, such as 998.11 (Hemorrhage complicating a procedure) for postoperative bleeding.