Anesthesia Coding Alert

Most payers will not reimburse for pain managementunless they have a precise description of the service, why it was provided, and the condition of the patient. This is a truism that can be translated to most medical practices, but in anesthesia pain management particularly it is unique and critical.

Modifiers are extremely important because they disclose exactly whats going on with the patient, says Lisa Hahn, anesthesia billing specialist with Lakefront Billing Service in Milwaukee, Wis. And, with the field of pain management growing, its imperative for accurate coding and recording and full reimbursement to keep abreast of which modifiers carriers accept for particular situations.

Use Modifiers Skillfully to Report Pain Services

Anesthesiologists use a select group of modifiers to report pain-management services, says B.J. Johnson, CPC, MPC, anesthesia coding specialist with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif. Following are modifiers anesthesiologists use most:

modifier -22 (unusual procedural services): Append this modifier to the procedure code when the anesthesiologist provides services beyond routine. For example, most patients do not require anesthesia during diagnostic procedures such as MRIs (magnetic resonance imaging) or CAT (computerized axial tomography) scans (anesthesia code 01922, anesthesia for non-invasive imaging or radiation therapy). However, physically challenged patients or infants might need anesthesia during the procedure. Modifier -22 is appropriate in this situation.

modifier -23 (unusual anesthesia): This modifier indicates services such as administering anesthesia for MRIs, CAT scans, radiation therapy or lumbar punctures for infants.

modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period): Johnson says anesthesiologists rarely use this modifier, but it is appropriate in some circumstances. For example, if an anesthesiologist has to see a patient with an implanted pain pump for a different pain problem, the service is reported with modifier -24 appended to the applicable procedure code.

modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service): Append this modifier when a patient requires an evaluation and management (E/M) service that is above and beyond the routine care associated with a procedure. Anesthesiologists often attach this modifier to report administering pain blocks. For example, an anesthesiologist completes an expanded history and physical that requires straightforward medical decision-making for a new patient (99202). If the workup indicates the need for a nerve block that same day, use 62311 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) appended with modifier -25 to show that the nerve block [...]