Anesthesia Coding Alert

When you're coding for pain management or anesthesia procedures, there are several highly useful modifiers you'll want to keep on hand for regular use. Here's a rundown that can help you when you need to explain the special circumstances surrounding a procedure, or when you have to give more details about your physician's work.

When you're coding for a procedure administered during a standard E/M visit, you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) when you file your next claim using 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) -- as long as the E/M service is significant and separately identifiable from the injection procedure, says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, with MJH Consulting in Denver.

Be careful using this modifier, though, says Vicky Varley O'Neil, CPC, CCS-P, owner of The Hazlett Group in St. Louis, Mo., in The Coding Institute audioconference "Modifiers 25 and 59 Best Practices That Keep Your Claims in the Clear." According to O'Neil, a large number of claims use modifier 25 unnecessarily, such as attaching the modifier to an E/M claim when no other service was performed on the same day. She says that you should never use modifier 25 on surgical codes or on services that resulted in the decision to perform surgery.

When your physician performs bilateral procedures during the same operative session, modifier 50 (Bilateral procedure) is the ammunition you'll need to pull from your arsenal.

For example: If you code for bilateral facet joint injections such as 64470 (Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; cervical or thoracic, single level) or 64475 (... lumbar or sacral, single level), you can put modifier 50 to good use. Depending on your payer, report the injections as one line item and append modifier 50, or report as two line items, appending 50 to the second code.

Remember: Bilateral procedures can dramatically increase your reimbursement. Keep in mind that submitting modifier 50 means you should expect to see 150 percent reimbursement for the procedure.

Be alert: Some payers require providers to use modifier RT (Right side) and modifier LT (Left side) to report bilateral injections, so you'll always want to be sure to check your individual payers' guidelines.

When you code for a procedure your physician performed during post-op -- and you need to show that it's serving as therapy following a surgical procedure -- rely on modifier 58 (Staged or related procedure or service by the same physician during the postoperative period).

For example: The next time your pain management specialist permanently inserts a percutaneous spinal cord stimulator array during the 90-day global period the trial insertion created, you can break out modifier 58, Hammer says, and append it to 63650 (Percutaneous implantation of neurostimulator electrode array, epidural).

Don't forget: The other uses for modifier 58 are indicating that a procedure was planned or anticipated, or that it was more extensive than the original procedure.

Use modifier 59 (Distinct procedural service) when you need to show that your physician performed two distinct services on the same day.

For example: One instance of this would be when the physician places a sciatic nerve block for postoperative pain management -- 64445 (Injection, anesthetic agent; sciatic nerve, single), for example -- on the same day that he also provides general anesthesia for surgery on the same patient's knee (01400, Anesthesia for open or surgical arthroscopic procedures on knee joint; not otherwise specified). You'd code this as 64445-59 for the block, along with 01400 for the anesthesia.

Don't forget: You can't use modifier 59 on E/M codes, O'Neil says, noting that you can only use this "modifier of last resort" if there isn't another valid modifier for your procedure.