Modifier -59 with pain blocks - why is it correct billing

nan.coder

Networker
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Saint Louis, Missouri
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Happy Halloween,

At our Ambulatory Surgery Center, in the pre-op are, the anesthesiologist performs a pain block (popliteal, ankle, interscalene, etc) to control post-op pain at the documented request of the Orthopedic Surgeon.

The literature that I'm finding on coding these pain block procedures, indicate that a -59 modifier should be appended to the pain block CPT code. I am hung up on the phrase "not ordinarily encountered or performed on the same day BY THE SAME INDIVIDUAL".

Can someone assist me in understanding why the -59 modifier can be used? Is it because "Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used"?

Thank you.

Nancy Boyle, CPC
St Louis Spine and Orthopedic Surgery Center
 

gost

Guru
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Charleston, WV
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Modifier 59 is used to describe a separately identifiable service. Anesthesia services are reported with ASA codes that are a little more broad in scope than most other procedure codes. Anesthesia services for a total knee arthroscopy would be reported with the same ASA code whether done under general anesthesia or with a regional block under MAC. If a regional block was used, reporting a separate block for post-op pain management may not be appropriate but if done under general anesthesia, the pain block is not part of the primary service and would be appropriate to report separately. Since the pain block code could be an inherent part of the anesthesia code (if the mode of anesthesia was a regional block under MAC), modifier 59 is necessary to identify it as a separately reportable service.
 
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