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Anesthesia Coding Alert

You Be the Coder:

Modifier -59

Published on Mon Oct 01, 2001

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: Medicare has been very inconsistent with reimbursing for epidurals when we submit with modifier -59. Which CPT codes does it consider payable with this modifier, and which ICD-9 codes will it reimburse for as supporting medical necessity?
 
New Jersey Subscriber

 

Answer: An epidural billed with modifier -59 (distinct procedural service) should be for pain management only and not for the delivery of anesthesia. These epidurals placed as a separate service on the same day as another procedure can apply to many situations, so it is difficult to list specific codes that are acceptable. The best advice is to code according to whatever the case involves. You also need to be sure that the services being billed are not bundled, and that modifier -59 is correct.
 
One example of medical necessity is a patient who has post-op bleeding after a coronary artery bypass graft (CABG); 998.11 (hemorrhage complicating a procedure) would be an appropriate ICD-9 code to submit. Code V58.49 (other specified aftercare following surgery) could be accepted as a secondary diagnosis related to postsurgical site pain. Different carriers may have certain codes they will accept for particular situations, so check with the carrier if you have questions about an individual case.

 

 

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