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Anesthesia Coding Alert

Reader Question:

Verify Why Carrier Changes -59 to -51

Published on Thu May 13, 2004

Question: When our physicians provide anesthesia for a case and then administer a post-op pain block, I bill the appropriate anesthesia code along with a block code and modifier -59. Why are some of our carriers changing the block modifier to -51 and reducing our reimbursement to half the allowable?

Indiana Subscriber Answer: Your insurer might change modifier -59 (Distinct procedural service) to modifier -51 (Multiple procedures) based on the way you reported each portion of the procedure. Blocks are considered procedures and are reported as type of service (TOS) 2 (Surgical service); anesthesia is not considered a procedure and is reported as TOS 7 (Anesthesia service).

Be sure to bill the initial anesthesia as TOS 7 and the nerve block as TOS 2. Also confirm that "pain" is the primary diagnosis for the nerve block (choose the ICD-9 code based on where the patient's pain lies). Reporting V45.89 (Other postprocedural states; other postprocedural status; other) and the reason for surgery as your second and third diagnoses can also increase your chances of reimbursement.
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