Anesthesia Coding Alert

Documentation explains the story, increases specificity Every coder knows that appending modifiers can help you report services more accurately and get appropriate reimbursement. The down side is that wading through the choices can bog you down, especially if you're new to pain management coding. Here, you get the lowdown on three common pain management modifiers for reporting multiple services, along with some expert coding tips. Pair Modifier -25 With E/M Service If your physician performs an E/M service on the same date that he performs another procedure for the patient, you'll want to get to know modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
Many pain management coders report modifier -25 success when new patients present to their practices. Example: The pain specialist completes a history, physical and medical decision-making (components of an E/M visit) to determine whether the patient is a good candidate for a requested nerve block and will be able to tolerate it well. If the physician administers the nerve block the same day, report the appropriate E/M visit code with modifier -25 appended, plus the code for the nerve block.
 
"You can bill the E/M only if this is the first time you've seen the patient and a decision for a procedure was made at this session," says Carolyn MacDonald, CPC, coding manager for New England Health Care Foundation/New England Medical Center Hospitals in Boston. "If the physician has already made the decision to do the procedure, you cannot bill for a pre-op E/M exam."
 
The physician may also perform the E/M visit later (in a different "session") on the same day; this can range from an actual procedure such as a separate injection to other services such as medication refills.
 
"This happens all the time in our office, and we generally get paid," says Robin Fuqua, CPIC, anesthesia coder for Jose Feliz, MD, in Escondido, Calif. "Just follow Medicare's requirements if you expect to get paid." (See "Follow Strict Guidelines to Collect Modifier -25 Pay" on page 19 for more on this.)

Modifier -51 Signifies Extra Services You already know to append modifier -25 if the physician performs an E/M service and another procedure during the same day. But what if he performs multiple procedures (not an E/M service) during the same session? That's when you should append modifier -51 (Multiple procedures) instead.
 
"We use modifier -51 most often when we're billing multiples of the same injection," Fuqua says. "In California, workers' comp carriers still use 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) for trigger point injections. So when we inject multiple muscle groups, we list each one separately. The [...]