Reader Question:
Epidurals
Published on Sun Oct 01, 2000
Question: Which CPT codes does Medicare consider to be payable with modifier -59, and which ICD-9 codes will they reimburse for as supporting medical necessity?
New Jersey Subscriber
Answer: An epidural billed with modifier -59 (distinct procedural service) should be used for pain management only. These epidurals that are placed as a separate service on the same day as another procedure can apply to many situations, so it is difficult to list specific codes that are acceptable.
One example of an acceptable code for medical necessity is a patient who has post-op bleeding after a coronary artery bypass graft (CABG). Code 998.11 (hemorrhage complicating a procedure) would be an appropriate code to submit. Code V58.49 (other specified aftercare following surgery) could be accepted as a secondary diagnosis related to postsurgical site pain. Check with the carrier if you have questions.
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