Wiki Pain Block Coding

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vmidla

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Anyone getting denials from Medicare or others who follow CMS guidelines for the following billed together -
27096
64475
77003-26
According to CCI edits they are allowed to be billed together - any thoughts?
 
Mod 59 should not be necessary for these codes. As long as you have DX codes that support medical necessity you should be reimbursed appropriately. Are you being denied for any these codes? Also, CMS may require G0260 instead of 27096.
 
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If your main source of anesthesia is General, then you definitely need a 59 modifier appended to the nerve block code.
 
since these are two seperate procedures mod 59 is necesary for the second procedure
 
I agree with coderguy - not bundled so -59 modifier is not necessary. I would also be looking at your Medicare carrier's LCD for covered/medical necessity diagnosis. What code is being denied and for what denial code?

Julie, CPC
 
vmidla said:
Anyone getting denials from Medicare or others who follow CMS guidelines for the following billed together -
27096
64475
77003-26
According to CCI edits they are allowed to be billed together - any thoughts?
Click to expand...
Try using modifier -51 on each procedure. We have had luck with being paid when these are appended with - 51
 
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