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consult with blood patch

  1. #1
    Talking consult with blood patch
    Clearnace Sale
    if an anesthesiologist does a consult and decides to do an epidural blood patch right there, can he get credit for the consult and the blood patch.

  2. #2
    It all depends on the referring provider's intent and documentation as well as your provider's documentation.

    CPT code 62273 has a global day of "0" and is considered minor surgery. The decision to perform minor surgery is included in the payment for the procedure and should not be billed as an E&M or consult.

    I, personally, do not bill a consult with a blood patch as the referring provider generally refers patient "for blood patch by anesthesia".

    Julie, CPC

  3. #3
    St. Joseph County, Indiana
    I agree with Julie and Vanessa.

    It depends on the intent of the referring physician. If the referring physician orders a blood patch then I can see not billing for the procedure. If the referring physician is referrng the patient to the pain specialist to treat their pain condition, then the pain specialist is the one making the decision for the blood patch. I would bill a consult/new pt visit.

    A quick note about the "decision for surgery" and minor surgery comment: It all comes down to the situation and documentation. There are many "0" global day procedures (such as nearly all pain management codes) that are appropriate with e/m codes. Julie's statement seemed to imply otherwise.

  4. #4

    Yes, the documentation has to support the E&M or consult. I realize in the chronic pain arena that your referrals may more easily qualify as a consultation, however, I'm also saying that just because a minor procedure is being performed on a new or existing patient it doesn't warrant an E&M or consultation charge in addition to the procedure . By adding the -25 modifier it is signifying a separately identifiable procedure. See the below excerpt from NCCI Chapter 1 pages 12/13.

    "If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.
    The E&M service and minor surgical procedure do not require different diagnoses. If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure. NCCI does contain some edits based on these principles, but the Medicare Carriers (A/B MACs processing practitioner service claims) have separate edits. Neither the NCCI nor Carriers (A/B MACs processing practitioner service claims) have all possible edits based on these principles."

    Julie, CPC

  5. #5
    St. Joseph County, Indiana

    Sorry if we've carried this discussion beyond what you were looking for, if you still awaka Julie brings up an interesting point.


    Your quote from the CCI is correct, however, I believe there is more to the story. Taken a face value, this would mean that the entire specialty of pain management would not be able to bill any new patient visits on the same day as a procedure. In practice, this is very common. Pt presents to a pain specialist. Physician decides on a tx plan and performs a procedure. I have billed this over 1,000 pt's with the same dx and no -25 modifier.

    Perhaps we are overthinking a simple blood patch question, but I love you input.

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