Neurology & Pain Management Coding Alert

Question: Our pain management specialist was in the midst of administering a trigeminal nerve block (64400) when he aborted it due to the needle penetrating the patient’s oral cavity. Should this be billed to insurance as a discontinued procedure with modifier 53, or not billed at all due to the complication?

Alaska Subscriber

Answer: If you look at the full descriptor of modifier 53 (Discontinued procedure), you read a further explanation: “Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding modifier 53 to the code reported by the physician for the discontinued procedure.”

Hence, modifier 53 is appropriate for reporting procedures that were discontinued. Since your pain management specialist is aborting the trigeminal nerve block, you report 64400 (Injection, anesthetic agent; trigeminal nerve, any division or branch) and append modifier 53 to this code. In addition, consider reporting 998.2 (Accidental puncture or laceration during a procedure, not classified elsewhere) to provide additional information to the payer regarding the complication.