Wiki POST OPERATIVE PAIN BLOCKS BEING DENIED BY FLORIDA BLUE

[adam@somnexanesthesia.com]

HAVE A FEW RECENT CLAIMS WHERE THE BLOCKS HAVE BEEN DENIED (64415 FOR VARIOUS PROCEDURES).

THIS IS THE EXPLANATION:

97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

ANY IDEAS WHY THIS IS HAPPENING?

THANKS

 

[roxannel]

Are you using the appropriate modifiers?

 

[adam@somnexanesthesia.com]

Are you using the appropriate modifiers?

The Florida Blue blocks have (historically) been paid without a 59 modifier.

 

[tec76]

You might try appending the 59 modifier to the block code. And, at least for Medicare claims, I would suggest adding block note verbiage to the effect that the block was both: (1) placed for post-op pain management and (2) performed at the surgeon’s request.

 

[adam@somnexanesthesia.com]

You might try appending the 59 modifier to the block code. And, at least for Medicare claims, I would suggest adding block note verbiage to the effect that the block was both: (1) placed for post-op pain management and (2) performed at the surgeon’s request.

WILL DO. I'LL LET YOU KNOW IF THIS WORKS. THANKS!

 

[adam@somnexanesthesia.com]

WILL DO. I'LL LET YOU KNOW IF THIS WORKS. THANKS!

FOLLOWING UP ON THIS. 59 WITH A NOTATION THAT YOU RECOMMENDED HAS PUSHED THE CLAIM THROUGH FLORIDA BLUE, AND IT WAS PAID! I AM TRYING MEDICARE TODAY. THANKS FOR YOUR HELP!