# modi



## susiemc (Jul 13, 2010)

I am in Anesthesia billing and need some guidance on determining the appropriate modifers to bilateral knee blocks -- Scenerio --

Procedure was bilateral knee replacement.

Along with the general anesthesia, bilateral blocks were placed as well. 
For the coding of the blilateral blocks - 

Would be coding for the blocks be -
64445-59 - for the first nerve block
64445-59-50-51 - for the second nerve block?
..or, does the -50 apply to the first block as well?

Is there any documentation to clearly support the determination of the applicable modifiers in this scenario? Thanks for any and all suggestions.


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## NIENAJADLY (Jul 22, 2010)

*bilateral knee blocks*

You would bill 64445-50, 59 unless your carrier has specific instructions (some like it on 2 lines: 64445-59, then 64445-50-59 for the 2nd block).  The -50 would note bilateral and most carriers are ok with it on one line.


Hope that helps.

Kellie


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## dwaldman (Jul 22, 2010)

Modifiers -51 and -59 (Q&A)

Question

Can both modifiers -51 and -59 be appended to the same code on the same claim? Should these modifiers ever be reported on the same claim form? 

AMA Comment

Since modifier -59 is to be used only if no more descriptive modifier is available, and the use of the -59 modifier best explains the circumstances, it would not be appropriate to append the -51 and -59 modifier to the same code on the same claim. However, there may be circumstances in which the -59 modifier is used on one code and the -51 modifier is appended to a separate code on the same claim form. 

http://www.cms.gov/MLNMattersArticles/downloads/MM6518.pdf

In the above article and in the claims processing manual they state that if the procedure is performed bilateral and it is code that is recognized by them as code you can append the 50 modifier, then one line with the 50. I am not aware of any carrier that wants 64445 64445 50. If it is situation that I don't think they want the 50 I would bill as 64445 RT 64445 LT instead w/ 59 in done with anesthesia on the same day.


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