Question: We’ve recently begun to receive claims for payment for 01402 and 62311 on the same date of service, related to the same diagnosis and procedure. Is the 62311 injection payable for pain management, post surgical?
Minnesota Subscriber
Answer: If your provider performs 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]) for pain management and not part of the anesthesia technique, you can code it separately by appending modifier 59 (Distinct procedural service).
Medicare also has additional limitations. The following is from the Medicare NCCI Manual: “An epidural injection (CPT® code 623XX) for postoperative pain management may be reported separately with an anesthesia 0XXXX code only if the mode of intraoperative anesthesia is general anesthesia and the adequacy of the intraoperative anesthesia is not dependent on the epidural injection. … An epidural or peripheral nerve block injection (code numbers as identified above) administered preoperatively or intraoperatively is not separately reportable for postoperative pain management if the mode of anesthesia for the procedure is monitored anesthesia care (MAC), moderate conscious sedation, regional anesthesia by peripheral nerve block, or other type of anesthesia not identified above.”
Below are four key points to be watched before submitting a separate claim for the post-op injection or catheter placement.