Question:
Our state’s Medicaid carrier denies our claims when we submit 62311 with modifier 59 for postoperative pain management. They say the 62311 is bundled with the anesthesia procedure code. How should we handle this?
Answer:
When you submit a code for postoperative pain management, be sure to include an appropriate diagnosis. Some payers will only reimburse for the pain management diagnosis codes from 719.xx (Other and unspecified disorders of joint) or 789.xx (Other symptoms involving abdomen and pelvis) if you’re billing for post-op relief not associated with the main procedure. For example, 719.46 (Pain in joint involving lower leg) might be appropriate for your claim. You could also include 338.18 (Other acute postoperative pain) for additional documentation purposes. Assign the pain management diagnosis to 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). Append modifier 59 (Distinct procedural service) to show that the post-op management is separate from anesthesia during the surgery.
Tip: Some insurance companies have specific policies regarding postoperative pain management. Check with your local carrier to verify whether this is the case, and follow those guidelines.
