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Pain Block Coding

  1. #1
    Default Pain Block Coding
    Medical Coding Books
    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?

  2. #2
    Default
    mod. -59 to 2nd proc?

  3. #3
    Default
    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.
    Last edited by coderguy1939; 06-30-2009 at 01:55 PM. Reason: HCPCS code

  4. #4
    Location
    Jamaica, NY
    Posts
    55
    Default
    If your main source of anesthesia is General, then you definitely need a 59 modifier appended to the nerve block code.

  5. Default
    since these are two seperate procedures mod 59 is necesary for the second procedure

  6. #6
    Default
    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

  7. Default
    Quote Originally Posted by vmidla View Post
    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?
    Try using modifier -51 on each procedure. We have had luck with being paid when these are appended with - 51
    Last edited by kgohs37110; 07-10-2009 at 12:10 AM. Reason: addition

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