How to Report Post-op Pain Blocks - ccmpro.com

1 When it comes to getting paid for post -oppain Blocks , not all payors require thesame documentation and proof of medicalnecessity. Some commercial carriers follow theMedicare edits and guidelines while others don t fol-low Medicare reimbursement potentially allow-ing for more aggressive coding and reporting. Here sa review of different Post-op pain directives. American Medical AMAsays it s appropriate to Report pain managementprocedures for Post-op analgesia separately fromthe administration of a general anesthetic. Whetherthe block procedure (insertion of catheter; injectionof narcotic or local anesthetic agent) occurs pre-operatively, post -operatively or during the proce-dure is immaterial, reads AMA CPT OCT 01; 9. TheAMA lists 2 exceptions, however. One, if the blockprocedure is used primarily for the anesthesia itself, Report the service using the anesthesia code , don t Report the block separately in a com-bined epidural/general anesthetic.

2 Keep in mind thateven though the AMA allows for separate reportingunder specific circumstances, commercial carriersmight have varying reporting and billing policies. Besure to verify them. Centers for Medicare & Medicaid says there s no separate payment for post -oppain management when provided by the physicianperforming an operative procedure, noting on page6 of the CMS Chapter 2 NCCI Manual that surgeonswho provide Post-op pain management are reim-bursed under a global payment policy related to theprocedure. CMS further states that anesthesia prac-titioners shall not Report Post-op pain proceduresunless separate, medically necessary services arerequired that cannot be rendered by the surgeon. In such cases, CMS says the surgeon is responsibleto document in the medical record the reason careis being referred to the anesthesia practitioner.

3 Surgeons may Report CPT codes 36000, 36410,37202, 62318-62319, 64415-64417, 64450, 64470,64475, and 90760-90775 only if provided for purpos-es unrelated to the [ Post-op ] pain management, theoperative procedure or anesthesia for the proce-dure, according to Medicare Global Surgery Rules. Local coverage determination policies. LCDpolicies provide documentation and medical neces-sity essentials for specific procedures. Your MAC/FImay offer LCD policies that provide more specificcoding directives for many procedures, includingcertain pain injections and Blocks . Many statesdon t have a specific LCD policy for the more com-OCTOBER2009 |OUTPATIENTSURGERYMAGAZINE49 REIMBURSEMENTD eciphering different Post-op pain directives is key to getting theproper Bentin,CCS-P,CPC-H, CMA | Baton Rouge, to Report Post-op pain BlocksPOST-OP ANALGESIAS omecarriers let you separately Report Post-op pain Post-op pain block proce-dures due to the CMS NCCIM anual directive that is already inplace.

4 For those states with LCDpolicies for pain Blocks for Post-op pain , review the policy inits entirety(see Read LCDs inTheir Entirety ).Documenting blocksWhile most pain managementproviders are usually on targetwhen describing injection proce-dures, the ball gets dropped toooften when it comes to document-ing Post-op pain Blocks . Detaileddocumentation is essential and thepost-op pain injection must beseparate and distinct from theanesthesia used to perform thesurgery. Many commercial carriersthat allow separate reportingadvise a separate operative reportor procedure note for the injec-tion. Likewise, many commercialcarriers have medical necessityand provider requirements. We found these examples ofgrossly deficient Post-op painblock dictation within operativereports that provided no separateoperative reports for the block : The patient was given ablock followed by endotrachealanesthesia.

5 Anesthesia: General endo-tracheal anesthesia with block . A scalene block was givenfor Post-op pain control. 50 OUTPATIENTSURGERYMAGAZINE| OCTOBER2009 REIMBURSEMENTRead LCDs in Their EntiretyIt s easy to misinterpret local coverage determination policies for peripheral nerveblocks if you make it through the medically necessary conditions but omit the remain-ing contents of the LCD containing the documentation requirements. Take, for exam-ple, the following excerpt from First Coast Service Options LCD: Medicare will consider peripheral nerve Blocks medically reasonable and neces-sary for conditions such as the following diagnostic and therapeutic purposes:When a single injection peripheral nerve block provides post -surgical pain control1. during the transition to oral analgesics2.

6 In those procedures that cause severe pain normally uncontrolled by oral analgesics3. in cases otherwise requiring control with intravenous or parenteral in cases where the patient cannot tolerate treatment with narcotics due to allergy orside effects, etc. If you read only the excerpt above and not the LCD in its entirety, you ll miss theremainder of the LCD that reads: Based on Medicare rules, regulations and Correct Coding Initiative (CCI) edits,nerve Blocks are not separately payable when done by the surgeon or the anesthesiaprofessional who provides anesthesia/analgesia for the procedure. When preemptiveanalgesia is performed by a provider other than the surgeon or the anesthesia profes-sional who provides anesthesia/analgesia for the procedure,there must be a com-pelling patient care reason for the involvement of the additional provider.

7 The rationalefor this approach must be clearly documented in the medical recordsmust be available and submitted upon request. So even though you can prove medical necessity per the LCD for the performanceof the Post-op pain block ,you must explain why an additional physician had to do theblock other than the surgeon or anesthesiologist in the case. But beware. One LCD pol-icy should in no way be interpreted and used as an overall coding policy. Cristina Bentin, CCS-P, CPC-H, CMASEPARATELY PAYABLE?If you take the timeto read Local Coverage Determination, you llknow whether you can expect to be reimbursedfor a nerve block for preemptive your state s LCD policies THE WEBW here s the detailed descrip-tion of the procedure? The clarifi-cation of the provider performingthe block ?

8 The differentiationbetween the anesthesia for thesurgery and the Post-op painblock? Follow these documenta-tion recommendations Clarify which provider provid-ed the Post-op pain service. Whoadministered the block the sur-geon, the anesthetist performinganesthesia for surgery or someoneelse? AMA and CMS differ inguidelines; verify with carriers. Provide the completedescription of the block (what,when, why, where, how and medsused) and ensure it isseparate/distinct from anesthesiafor the surgery. Indicate the med-ication (steroid, neurolytic oranesthetic); specify the method(catheter, ablation or injection);list the site (cervical, thoracic orlumbar); specify temporary ver-sus permanent placement ofcatheters; and indicate the specif-ic condition or diagnosis. Ensure there is separate/dis-tinct documentation apart fromop note describing the surgery.

9 Suggest the surgeon dictatethe reason for the transfer of careto another provider (medicalnecessity) when , expect that you llneed to verify documentation andprovider requirements for carri-ers that allow separate reportingof Post-op pain Blocks . OSMMs. Bentin afrequent contributor, is the principal atCoding Compliance Management. OCTOBER2009 | the a tough economy, it s critical to contain costs, increase throughput andensure full reimbursement for every procedure you MD software replaces dictation and transcription, resulting in complete,coding-ready and image-enhanced operative notes with CPT and ICD MD software allows for same-day bill submission and eliminatesthe risk of lost revenue due to EHR,designed for busy, cost-conscious ASCs, offers robustelectronic documentation and document imaging for all elements of the patient encounter.

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