Urology Coding Alert

Question: Can I report an office visit with a bilateral inguinal cord block? I am being denied the office visit per CCI Edits . Is there a modifier I could append to the office visit?

Texas Subscriber

Answer: If the E/M service is truly a separate visit and examination, you should be able to report a separate E/M code, appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

For a bilateral inguinal cord block, report 64425 (Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves). Append modifier 50 (Bilateral procedure) since your urologist performed the procedure bilaterally.

Note: Medicare and most other payers will not pay the operating surgeon for a local anesthetic block prior to surgery. In the above case, no surgical procedures were mentioned and the local anesthesia may have been given to relieve scrotal and/or testicular pain.