Health Information Management

Tip: Use correct modifiers for pain management codes

APCs Weekly Monitor, July 23, 2010

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Although -RT and -LT are the most common modifiers used for pain management, coders may need to consider others. Consider some potential scenarios related to the percutaneous implantation of a neurostimulator electrode array (63650).

If a physician terminates a procedure before administration of anesthesia, append modifier -73 (discontinued outpatient hospital/ASC procedure prior to the Administration of anesthesia). The facility must have expended significant resources, which usually means the patient is prepared for surgery, has an IV, and has received preoperative pain medication. Medicare reimburses facilities approximately 50% of the allowable payment when modifier -73 is appended.

However, if anesthesia was administered before the physician terminated the procedure, append modifier -74 (discontinued outpatient hospital/ASC procedure after administration of anesthesia). In this case, Medicare pays 100% of the allowable reimbursement. In either case, ensure your documentation supports use of the modifier.

Modifier -78 (unplanned return to the operating room by the same physician) is used when a patient returns to the OR for a related procedure during the global period. Facility global periods are 24 hours from the time the procedure performed began. For example, append modifier -78 when a patient experiences a postoperative hemorrhage in the recovery area and needs to return to the OR.

Use modifier -52 (reduced services) when a procedure was partially reduced or eliminated at the physician’s discretion. Medicare generally reimburses 50% of the allowable payment when modifier -52 is appended.

This tip was adapted from “Cure what ails your pain management coding” in the July issue of Briefings on APCs.



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