Below, the following physician, Laxmaiah Manchikanti, MD, wrote to medical director of the National Correct Coding Initiative and address among other edits, the following:
"Column 1 Codes 20552 and 20553 are included in Column 2 with 1 modifier (allowed)
CPT codes 62310, 62311, 62318, 62319, 64408, 64410, 64435, and 64455, which are
epidurals and multiple nerve blocks. Our concern is mainly with 62310 and 62311.
Unfortunately this will not always apply. A patient may have a trigger point injection in
the cervical region. Thus, if trigger point injections are billed, one cannot bill for an
epidural injection with 62311; likewise, if a trigger point injection is performed in the
lumbosacral area, one cannot perform 62310, the cervical epidural injection.
This creates questions in the minds of physicians in providing care. Further, most
providers have been experiencing an inability to override with modifier 59 as Medicare is
considering to pay only for the lowest code and decide not to pay for the other codes.
This will create further appeals, which may not be worthwhile, as it will create too many
problems. Even though this may not be a strategic issue for you, it is extremely important
in providing care. To override this, providers will be calling patients to return on multiple
occasions or they may just stop doing the procedures or billing them, which can result in
a loss to the providers."
http://www.asipp.org/documents/April202011LettertoNilesRosen.pdf
Like he mentions the codes with the higher RVUs ( 62310 and 62311) are column two codes to column one code 20552. Currently, I am not aware of any document that explains when modifier 59 would be appropriate with some of the edits they do with pain management procedures. A different anatomical site is seen such as how the shoulder is described below
"From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes treatment of a single anatomic site. Treatment of posterior segment structures in the ipsilateral eye constitutes treatment of a single anatomic site. Arthroscopic treatment of a shoulder injury in adjoining areas of the ipsilateral shoulder constitutes treatment of a single anatomic site."
In his letter he describing a scenario of a cervical area trigger point with a lumbar epidural and stating other providers not be able to receive reimbursement or "override" the edit. I am not currently seeing trigger points and epidurals performed in the same setting so I don't have a lot of experience with the carrier's response. What you describe seems like anatomically they are different sites for different conditions and in my personal opinion the modifier 59 would be appropriate but this is soley my interpretation and not based on a published article.