Anesthesia Coding Alert

Question: When our physicians provide anesthesia for a case and then administer a post-op pain block, I bill the appropriate anesthesia code along with a block code and modifier -59. Why are some of our carriers changing the block modifier to -51 and reducing our reimbursement to half the allowable?

Indiana Subscriber

Answer: Your insurer might change modifier -59 (Distinct procedural service) to -51 (Multiple procedures) based on the way you reported each portion of the procedure. Carriers classify blocks as procedures that you report as type of service 2 (Surgical service); anesthesia is reported as TOS 7 (Anesthesia service) because carriers do not consider it a procedure. Be sure to bill the initial anesthesia as TOS 7 and the nerve block as TOS 2.

Also confirm that "pain" is the primary diagnosis for the nerve block (choose the ICD-9 code based on where the patient's pain lies). You can report V45.89 (Other postprocedural status; other) and the reason for surgery as your second and third diagnoses to increase your chances of appropriate reimbursement.

If the carrier continues to change the modifier and adjust your reimbursement, talk to the carrier's medical director to ensure that you understand their guidelines for post-op pain blocks and they understand what you're reporting. Explaining the situation might help you collect the correct reimbursement.