Anesthesia Coding Alert

Check these areas if they keep coming back

If your post-op pain management claims are returning unpaid, it's time to confirm that you're following all of the carrier's guidelines. Be sure you can check off these necessary items:
You have the request in writing.

You have reported the correct type of service (TOS).

There is clear documentation of the catheter placement.

You have identified whether the carrier has a limit to the number of post-op days allowed (many cap this at three days).

You have verification of whether you're coding for PCEA or PCA.

You are only reporting post-op management once per day, even if more than one physician checks on the patient during the day.

Your primary diagnosis is pain, not the reason for the initial surgery. "Our most common reason for denial is that the post-op care is included in the anesthesia service - even when we've appended modifier -59 (Distinct procedural service)," says Donna Howe, a coder with Anesthesiology Consultants of Eastern Connecticut in Manchester. "Getting surgeons in the habit of putting their request for post-op pain control in writing can help you code correctly and receive reimbursement."