Anesthesia Coding Alert

Question: I’m coding for a Medicare patient who required surgery for a prosthetic hip dislocation. Later the same day the patient was taken back to the OR for the same diagnosis and a repeat of the prior surgery due to the prosthetic hip dislocating again. This repeat surgery was done by the same surgeon on the same day (2 hours apart), but a different anesthesiologist was involved. What would be the correct modifier to use for a return to OR with a different anesthesiologist?

Oregon Subscriber

Answer: The anesthesiologist involved in the first procedure of the day will submit the appropriate anesthesia code, such as 01200 (Anesthesia for all closed procedures involving hip joint) for a closed approach or 01210 (Anesthesia for open procedures involving hip joint; not otherwise specified) for an open approach. Append modifier AA (Anesthesia services performed personally by anesthesiologist) to show the anesthesiologist was responsible for the care himself.

The second anesthesiologist will report the anesthesia code, also with modifier AA. A surgeon in this situation would append 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), but that isn’t appropriate here since post-op periods don’t apply to anesthesiologists. Instead, you could include modifier 59 (Distinct procedural service) on the second anesthesiologist’s claim.

Don’t worry: Although your providers might be reporting the same anesthesia code for their services, the different NPIs associated with each claim and the different start/end times for the procedures will support two claims.