Wiki Modifier -59 and New -X {EPSU}

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enancy79

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Which of the new modifiers would replace the -59 previously used for post-operative pain injections. Anesthesia sometimes is requested to provide the procedural anesthesia and also a separate injection for pain control post operatively. For example, these injections are sometimes lumbar or femoral for a total knee or brachial for a total shoulder, etc. Opinions ? Examples ? Scenarios?:confused:
 
enancy79 said:
Which of the new modifiers would replace the -59 previously used for post-operative pain injections. Anesthesia sometimes is requested to provide the procedural anesthesia and also a separate injection for pain control post operatively. For example, these injections are sometimes lumbar or femoral for a total knee or brachial for a total shoulder, etc. Opinions ? Examples ? Scenarios?:confused:
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This should not be separated. Post operative pain injections are done at the conclusion of a THA or TKA. According to the GSD for both types of procedures, " local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation" are included in the global service package.
 
To clarify: In these situations, the injections are performed specifically for post operative pain, requested by the surgeon and are not a part of the anesthetic for the procedure.
 
This is a direct quote from Stephanie Ellis with Ellis Medical Consulting
"Medicare has issued specific guidance that in most cases they consider Injections
performed routinely for Post-Operative Pain Control to be bundled into the
orthopedic surgeon?s global services (even when the Injection is performed by a
different physician), so we would recommend not billing them to Medicare.
If Injections are given for Post-Op Pain Control after Knee Surgery, the 64447
code for a Femoral Nerve Block Injection or code 64448 for a Femoral Block by
Catheter using a Pain Pump would be used. Use code 64450 for Blocks for Ankle
and Foot procedures."

We have billed these on numerous occasions but not a single payer is paying for them because they agree with Medicare that an injection for post-op pain is inclusive to the global service package of the surgery. I still have one physician who I am working with on these. 64447 has an indicator '0' per CCI edits which means that it should not be billed. Any medication, drugs, or anesthetics are part of the global service package.
 
Commercial payers will pay it, but Medicare will not pay for Post OP pain injections because they bundle it into procedure.

If you bill commercial, you have to make sure that you put the anesthesiologist as the one who administered the injections. This also has to be documented separately from the anesthesia record and in this documentation it has to state that the surgeon requested the injection. In the Surgeon's op report, they have to state the pain injection was given by the anesthesiologist.

I work for an ASC in Southern California and do not have problems getting commercial, private & Workers' Comp to pay for PO pain injections
 
drakena74 said:
Commercial payers will pay it, but Medicare will not pay for Post OP pain injections because they bundle it into procedure.

If you bill commercial, you have to make sure that you put the anesthesiologist as the one who administered the injections. This also has to be documented separately from the anesthesia record and in this documentation it has to state that the surgeon requested the injection. In the Surgeon's op report, they have to state the pain injection was given by the anesthesiologist.

I work for an ASC in Southern California and do not have problems getting commercial, private & Workers' Comp to pay for PO pain injections
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Just out of curiosity, are they all paying because you put 59 modifier on each one and they are just sailing through? or is it because its appropriate to pay?
 
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