Anesthesia Coding Alert

Know when same-day services qualify as 'separate' Anesthesia providers often perform more than one service for patients on the same day, which means modifier -59 (Distinct procedural service) often applies to your claims. Take the time to understand its nuances, and you'll be rewarded with accurate claims and sufficient reimbursement. Check the Times of Multiple Sessions When you append modifier -59, you indicate to the carrier that the anesthesiologist performed more than one service for the patient. But the services you report with modifier -59 must qualify as "distinct" from each other instead of being services that normally go together. The physician might perform these services during separate sessions or might perform multiple services during the same session that are unrelated. Note: For tips on distinguishing modifier -59 from modifier -51 (Multiple procedures), see "Make Modifier -51 Your Friend".

"The descriptor's use of the word 'distinct' is what seems significant here," says Lori Mehlbauer, an anesthesia coder in Louisville, Ky. You must be able to show that the services were separate from each other before reporting modifier -59. Mehlbauer and Joseph T. Fisher, CPC, with Healthcare Administrative Partners LLC, in Media, Pa., offer three common scenarios using modifier -59 with anesthesia or pain management services: Placement of an epidural catheter for postoperative pain relief. The physician might place the epidural catheter just prior to surgery or following the case. These scenarios count as "different sessions" and qualify for modifier -59 because the epidural placement is not part of the procedure's anesthesia and is not included in the global anesthesia fee. Report CPT 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) and append modifier -59. Anesthesia care when a patient returns to the operating room (OR) the same day. Reporting modifier -59 for cases when a patient returns to the OR is appropriate for the anesthesiologist, but you'll rarely report modifier -78 (Return to the operating room for a related procedure during the postoperative period). Surgeons primarily use modifier -78. Nerve blocks with other services. Include modifier -59 when you code a nerve block (644xx series) for postoperative pain relief. Pain management practitioners also use modifier -59 to report multiple services such as a nerve block (644xx) or joint injection with a trigger point injection of a completely different area. For example, code a large-joint injection during the same session as a trigger point of the elbow with 20610 (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) and 20552 (Injection[s]; single [...]