Anesthesia Coding Alert

Question: When an anesthesiologist administers general anesthesia for a procedure and then also performs a postoperative pain block, is the pain block subject to multiple-procedure guidelines?

Maryland Subscriber

Answer: Some coders prefer not to use modifier -51 (Multiple procedures) unless absolutely necessary because it often results in the carrier cutting the procedure fee in half. Also, Medicare carriers and some private carriers don't want you to append modifier -51, and prefer to assign it themselves as appropriate after you have submitted the claim.
 
A successful alternative for many coders is to append modifier -59 (Distinct procedural service) to postoperative pain blocks with supporting documentation. Before reporting modifier -59, be sure to include documentation for the post-op block. Remember that you can separately report for a block only when it was not used to deliver anesthesia during the procedure.
 
CPT created modifier -59 primarily to allow you to report multiple procedures performed on the same day for different sites. These distinct services are paid at full value instead of being subject to the multiple- procedure guidelines. If the second service is post-operative pain management, use pain as the diagnosis, report V45.89 (Other postprocedural status; other) for the surgery and add the appropriate diagnosis code for the original surgery.