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Question: If an epidural catheter is inserted with the intention of providing postoperative pain management, does it matter whether it is placed at the beginning, middle, or end of the procedure as long as it is not utilized for the procedure? Also, our coders have a difference of opinion about reporting modifier 59. What is the correct modifier to report?

Colorado Subscriber

Answer: As long as the postoperative pain management, either by injection or continuous catheter, is separate from the mode of anesthesia, it doesn鈥檛 matter whether it is placed before, during, or after the procedure. According to Chapter 2 of the National Correct Coding Initiative (NCCI) 鈥渇or postoperative pain management in patients receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or postoperative pain management in patients receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or regional anesthesia by epidural injection as described above may be administered preoperatively, intraoperatively, or postoperatively.鈥� The correct modifier will depend on the payer.

For example, in February 2024 the Medicare Learning Network (MLN) sent out a bulletin specifically addressing this, reporting 鈥渕odifiers XE [Separate Encounter, a service that is distinct because it occurred during a separate encounter], XS [Separate Structure, a service that is distinct because it was performed on a separate organ/ structure], XP [Separate Practitioner, a service that is distinct because it was performed by a different practitioner], and XU [Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service] are valid modifiers. These modifiers give greater reporting specificity in situations where you used modifier 59 [Distinct Procedural Service] previously. Use these modifiers instead of modifier 59 whenever possible. Only use modifier 59 if no other more specific modifier is appropriate.鈥� However, other payers may still require a 59 modifier.

Kelly D. Dennis, MBA, ACS-AN, CANPC, CHCA, CPMA, CPC, CPC-I, Perfect Office Solutions