Post-Operative Pain Management and Breast Reconstruction

January 4, 2018

Question:
My physician consistently reports CPT 19364 for a breast reconstruction with free flap and 64421 for post-operative pain management and the payors are denying CPT 64421 with Modifier 59. How can I get paid for both procedures?  Is there another code I can use?

Answer:
CPT 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional block) is included in 19364 (Breast reconstruction with free flap) and cannot be reported separately.  In addition, both codes are bundled under NCCI and cannot bypass the edit even with Modifier 59.  There is not another code you can use to get paid for post-operative pain management as it is included in the breast reconstruction.

*This response is based on the best information available as of 01/04/18.

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