Anesthesia Coding Alert

Question: We are billing for anesthesia and have a Blue Shield claim that needs five modifiers. I understand the claim only allows for four modifiers, but I believe all five are important to correctly processing and paying this claim. An anesthesiologist directed a resident using monitored anesthesia during a screening colonoscopy that converted to a diagnostic colonoscopy. The patient is classified with a physical status of P3. I’m looking to report anesthesia code 00811 with modifiers AA, GC, QS, PT, and P3. What’s your advice for reporting this service on a claim form only allows four modifiers?

Minnesota Subscriber

Answer: It seems that all the modifiers you list are appropriate as described. The coding solution is simpler than you expect: Report 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified) for the encounter with modifier 99 (Multiple modifiers) on the service line. Then list all the applicable modifiers in the description:

• AA (Anesthesia services performed personally by anesthesiologist)
• GC (This service has been performed in part by a resident under the direction of a teaching physician)
• QS (Monitored anesthesia care service)
• PT (Colorectal cancer screening test; converted to diagnostic test or other procedure)
• P3 (A patient with severe systemic disease)

Tip: You should report payment modifiers before statistical modifiers, so the correct order on your claim should be AA, P3, and PT (payment modifiers) followed by GC and QS (statistical modifiers). This should help ensure correct reimbursement, but monitor the payment to make sure it was processed as expected. Also verify that you have adequate documentation to support each of the modifiers, such as diagnosis codes supporting the P3 physical status assignment.