Anesthesia Coding Alert

Find out which modifiers should always be at your fingertipsWhen you're coding for pain management or anesthesia procedures, there are several highly useful modifiers you'll want to keep on hand for regular use. Here's a rundown that can help you when you need to explain the special circumstances surrounding a procedure, or when you have to give more details about your physician's work.Guarantee Your Same-Day ReimbursementWhen you're coding for a procedure administered during a standard E/M visit, you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when you file your next claim using 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) -- as long as the E/M service is significant and separately identifiable from the injection procedure, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver.Be careful using this modifier, though, says Vicky Varley O'Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis, Mo., in The Coding Institute audioconference "Modifiers 25 and 59 Best Practices That Keep Your Claims in the Clear." According to O'Neil, a large number of claims use modifier 25 unnecessarily, such as attaching the modifier to an E/M claim when no other service was performed on the same day. She says that you should never use modifier 25 on surgical codes or on services that resulted in the decision to perform surgery.Bring in Bonus Bilateral Billing BucksWhen your physician performs bilateral procedures during the same operative session, modifier 50 (Bilateral procedure) is the ammunition you'll need to pull from your arsenal.For example: If you code for bilateral facet joint injections such as 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) or 64475 (... lumbar or sacral, single level), you can put modifier 50 to good use. Depending on your payer, report the injections as one line item and append modifier 50, or report as two line items, appending 50 to the second code.Remember: Bilateral procedures can dramatically increase your reimbursement. Keep in mind that submitting modifier 50 means you should expect to see 150 percent reimbursement for the procedure.Be alert: Some payers require providers to use modifier RT (Right side) and modifier LT (Left side) to report bilateral injections, so you'll always want to be sure to check your individual payers' guidelines.Plan Ahead for Post-Op ProceduresWhen you code for a procedure your physician performed during post-op -- and you need to show that it's serving as therapy following a surgical procedure -- rely on modifier 58 (Staged or related procedure or service by the same physician during the postoperative [...]