Anesthesia Coding Alert
Always Append Modifier 59 with Pain Block Code
Question: We do billing for both the anesthesiologist and the CRNA. We have had a couple of denials on a pain block because it says it’s “not allowed as separate service on claim.” These are being billed separately. We are using the appropriate modifiers (QK or QY for the doctor and QX for the CRNA). Do you have any suggestions on what else should be done?
Arizona Subscriber
Answer: Different payers have different guidelines for billing postoperative pain blocks. Confirm with the payer the specific reason for your denial so you can decide on the best coding option. Just ensure that you also append modifier 59 (Distinct procedural service) with the code you report for the pain block.
Remember: Medical direction modifiers QY (Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist), QK (Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals), and QX (CRNA service: with medical direction by a physician) do not belong on non-anesthesia codes. Pain blocks are considered surgical procedure codes so the anesthesia modifiers do not apply.
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