Anesthesia Coding Alert

Keeping track of modifiers can be confusing because some modifiers (such as - 58, -78 and-79) primarily may be used for pain management while others are for anesthesia services. Taking the time to learn about the different modifiers and ensuring that youre using the correct ones in the right situations is key to correct payment.

Pain Management or Anesthesia Services

Most modifiers that apply to anesthesia can be divided into two groups, according to Mark DiDonato, manager of practice activities in the department of anesthesiology at Thomas Jefferson University Hospital in Philadelphia. Several of them are primarily used in association with pain management services, and the others are used in conjunction with anesthesia services for surgery.

Based on these groupings, coding may vary by carrier or by state, so check your local guidelines. Appendix A (pages 455-460) of CPT 2000 provides definitions and instructions for each modifier. Below is an outline of the most commonly used anesthesia pain services modifiers with examples and typical situations.

Pain Services Modifiers

Modifier -22 (unusual procedural services): Use this modifier when an anesthesiologist provides services that are greater than what is usually offered for a procedure. For instance, it would be appropriate to use it for CT scans or MRIs on infants or handicapped individuals, or a nerve block or injection that required several attempts.

Modifier -25 (significant, separately identifiable evaluation and management service by same physician on same day of the procedure or other service): Use in conjunction with pain procedures, such as a patient who is referred to an anesthesiologist for a nerve block. The physician conducts a history, physical and medical decision making (components of an evaluation/management [E/M] visit) to be sure that the patient is a good candidate for the procedure and will be able to tolerate it well. The E/M visit (99###-99###) would be coded with the -25 modifier if the nerve block is done on the same day. The E/M visit also can be performed later (in a different session) on the same day. This might happen if a postoperative block did not work and the patient needs to be evaluated for a different type of pain management regimen.

Modifier -26 (professional component): Certain procedures such as fluoroscopy and tracheoesophageal echo are combinations of a physician and technical component. This modifier is used to document the professional component of a service when the physician does not own the equipment. For example, an anesthesiologist performs an epidural steroid injection (ESI) under fluoroscopy, but the hospital owns the fluoroscopy equipment. He or she would bill for the ESI (62311, injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or [...]