Anesthesia Coding Alert

Follow these 5 tips for correctly reporting multiple PM services

Anesthesia-only coders might not use modifier -51 (Multiple procedures) very often, but pain management coders are a different story. If you code for pain management services, correctly appending modifier -51 can be one of your best reporting tactics. Follow these five tips to determine when modifier -51 is appropriate.

Tip 1: If you are reporting services with modifier -51, check whether the procedure falls under the multiple-surgery rules. These procedures are easy to find in CPT Codes with the "circle/slash" icon beside the code, which indicates the service is "modifier -51 exempt." That means you cannot report modifier -51 with codes

Report modifier -51 when the provider performs multiple procedures -- excluding E/M services -- at the same session. Anesthesia providers bill services based on the highest-base procedure the surgeon performs, regardless of how many procedures the surgeon completes. You won't report modifier -51 in conjunction with anesthesia services, but you can use it for pain management.

Example: Pain management practitioners commonly use modifier -51 for services such as multiple intercostal neurolysis. Report the first injection as 64620 (Destruction by neurolytic agent, intercostal nerve), and report 64620-51 on separate lines for each additional injection showing this symbol. One familiar code that anesthesiologists use with this designation is 36620 (Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous). "Also check the Medicare fee schedule if you have questions about multiple-surgery rules," says Tonia Raley, CPC, claims manager with Medical Information Systems in Phoenix. "It lists each CPT code and whether multiple-surgery rules apply."

Tip 2: Another thing to note in CPT is whether you're reporting an add-on code for the service (such as 64479, Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level; and +64480, ... cervical or thoracic, each additional level [list separately in addition to code for primary procedure]). You only report add-on codes (those noted by a "plus" icon beside the descriptor) in conjunction with another service, so the code itself tells the carrier that the provider performed multiple services. Appending modifier -51 to the claim is not necessary. CPT lists all add-on codes in Appendix D.

Tip 3: One important consideration with reporting modifier -51 is that the quarterly edits from the National Correct Coding Initiative focus on whether you can perform or bill certain services during the same session. Keep an eye on these edits to ensure that any multiple procedures you're reporting with modifier -51 are still acceptable.

Tip 4: Don't fall into the trap of automatically appending modifier -51 to the second procedure during a session, Raley says. Carriers reduce your reimbursement by 50 percent when you report modifier -51, so append it to the lower-based procedure. For example, the physician must implant a catheter before placing a programmable infusion pump. Append modifier -51 to the first procedure (62350, Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy) instead of to the follow-up procedure (62362, Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming).

Tip 5: Some Medicare carriers use certain modifiers for tracking, and they request that you sometimes include modifier -51 for statistical purposes. Verify whether this is the case for your carrier and the procedure you're reporting.