Ob-Gyn Coding Alert

Question: What modifier is used when billing a paracervical block (64435) with a conization of the cervix (57522)? Ive been receiving rejections recently and have not before.

Annette King
Sutter Medical Foundation/Sutter Health
Sacramento, Calif.

Answer: If you are billing 64435 (injection, anesthetic agent; paracervical [uterine] nerve) with 57522 (conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision), you are probably getting rejections because the payer considers the anesthesia to be included in the conization procedure. The correct modifier is -51 (multiple procedures). CPT says local infiltration is included in the surgical procedure, but some will argue that a paracervical block is a regional anesthesia, not local. The payer, on the other hand, reads the description of the procedure as injection of anesthetic into the area and calls it a local. You need to interpret the denial and appeal, unless the payer has a policy in place that says they will not pay the surgeon for also doing the anesthesia.