Anesthesia Coding Alert

Question: Can I append modifier -57 (Decision for surgery) when an initial pain care consultation and a procedure are performed during the same visit?

Nebraska Subscriber

Answer: Whether you can append modifier -57 to a code depends on what procedure was performed.
 
If the patient comes for a pain consult and the physician determines (after conducting the patients history and physical) that a pain-relief procedure should be performed (such as a trigger point injection, 20552, Injection[s]; single or multiple trigger point[s], one or two muscle[s]; or 20553, single or multiple trigger point[s], three or more muscles), you can append modifier -57 and get paid for both services. Modifier -59 (Distinct procedural service) is not appropriate in this case because the two services in question are related.
 
If the procedure is considered major (i.e., has a 90-day global period), then adding modifier -57 to the E/M consult code is appropriate. If the procedure has a less-than-90-day global period or no global period, append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the consult code instead. Services that qualify for modifier -25 include all starred (*) procedures in CPT as well as excisions of benign lesions (11400-11446) and malignant lesions (11600-11646).

  You Be the Coder and Reader Questions were provided by Donna Howe, anesthesia coder with Anesthesiology Consultants of Eastern Connecticut in Manchester.