Wiki which new 59 modifier with penile block?

[meenda]

Is anyone using one of the new 59 modifiers when you bill a penile block with a circumcision? I'm not sure which one should be used....so far I have not had denials for just using 59, but I'm sure the denials will be coming.... can anyone help??

 

[mattra]

Per CPT guidelines, a block is one of the items included in the surgical package. Billing the penile block separately would be inappropriate unless performed for some purpose other than pain relief during the procedure.

Here is the guideline:
"By their very nature, the services to any patient are variable. The CPT codes that represent a readily identifiable surgical procedure thereby include, on a procedure-by-procedure basis, a variety of services. In defining the specific services "included" in a given CPT surgical code, the following services related to the surgery when furnished by the physician or other qualified health care professional who performs the surgery are included in addition to the operation per se: Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical)
Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals
Writing orders
Evaluating the patient in the postanesthesia recovery area
Typical postoperative follow-up care"