Budget-friendly ICD-10-CM Rapid Coder charts – code faster in 2019! |Learn More >>
Anesthesia Coding Alert

You Be the Coder: Modifier 78 Might Not Be Best for OR Return

- Published on Wed, Feb 15, 2012
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 [...]

Get 14-Day Fully-Functional Free Trial of Physician Coder

Get access to all your specialty alerts and archived articles along with some comprehensive tools including:
  • Code Search for CPT®, HCPCS, ICD-9 and ICD-10
  • CCI Edits Checker
  • Part B Fees, MUEs
  • CPT-ICD-9 CrossRef
  • CPT® ↔ ICD-9 ↔ ICD-10 CM Crosswalk
  • LCD/NCD Lookup
  • CMS 1500 Claims Scrubber
  • NDC ↔ CPT/HCPCS CrossReference
First Name: *
Last Name: *
User Name: *
E-mail: *
Phone: *
Choose Speciality*
Please enter the characters shown in box*