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

nan.coder

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

Medical Coding Books



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
 

drakena74

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Pain blocks can only be performed by the Anes if you want to get paid. If the surgeon performs the block, it will not get paid. They are also in CCI edits as a second column to most Ortho sx codes you're billing/coding it with. If you look on the Anesthesia org website, they also have documentation regarding the pain blocks. It is correct coding based on those factors.
 

thomas7331

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Yes, the NCCI manual explains that bundling of nerve blocks applies to the case where it is performed by the same provider who is doing the primary procedure. Since you're coding the ASC facility, I would use modifier XP instead of 59 to more specifically indicate that you are unbundling due to the fact that the procedures were performed by separate providers.
 
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