Which Anesthesia Code and Modifier to Use For Cancelled Procedure?

Scenario: There was a patient scheduled for a colonoscopy with biopsy; he experienced an episode of syncope in the pre-op area while the nurse was placing an IV. The physician called off the procedure; as such, which anesthesia code and modifier should I use to describe this?

Solution: Begin by checking whether your payers have definite guidelines for reporting cancelled cases. If the physician cancels the procedure after the patient is prepared for surgery but before induction starts, the payer may ask you to report 01999 (Unlisted anesthesia procedure[s]) with modifier 53 (Discontinued procedure). Other payers might call for the proper anesthesia code for the intended procedure in addition to modifier 53.

Remember: The entire definition for modifier 53 indicates not to report it for elective cancellation of a procedure before induction. But then some insurance companies may request the modifier despite that direction.

You need to include reports and additional notes in box 19 or the electronic equivalent (such as “cancelled before induction, but after preparation").

After the induction, if the physician cancelled the procedure, surgical procedure code 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) crosses to 00810 (Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum).

Heads up: If the service took place in an outpatient hospital or ambulatory surgical center, some payers need modifier 73 (Discontinued outpatient procedure prior to anesthesia administration) or modifier 74 (Discontinued outpatient procedure after anesthesia administration).

Bear in mind: You should point to the reason for the cancellation of the surgery by reporting diagnosis codes V64.1 (Surgical or other procedure not carried out because of contraindication) and 780.2 (Syncope and collapse). Depending on when the physician cancelled the case, you may also report the diagnosis for the colonoscopy.

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