Anesthesia Coding Alert

Check these 5 areas to help claims through the process

It happens all the time - so often, in fact, that many coders probably don't think twice about how to report postoperative pain epidurals. The mind-set changes, however, when a carrier suddenly stops paying for the service but doesn't explain why. That's when it's time to re-evaluate your coding game plan to check whether the problem is on your side of the process - and to know how to fix it. Start With Request and TOS Surgeons typically request post-op pain epidurals for patients following cardiac surgery, joint replacement or other complex procedures, says Cindy Clark, anesthesia coding supervisor with the physician group Anesthesiology Consultants in Savannah, Ga. Because the pain practitioner only provides the service at the surgeon's request, be sure your physician documents that request - in writing - and includes it in the patient's medical record.

Another up-front detail to consider is whether you're reporting the correct type of service (TOS). Be sure to bill the initial surgery's anesthesia as TOS 7 (Anesthesia service) and the post-op pain service as TOS 2 (Surgical service). If the same physician handles both services, some coders recommend filing two separate claims to differentiate the procedures. Investigate the Catheter's Use Verify with the pain physician whether he placed the patient's catheter for use during the surgery or solely for post-op pain management. If he used the catheter to provide anesthesia during the procedure, you cannot separately report its use for post-op pain relief on that same day.

Some coders wonder if they can add the catheter's insertion time for additional reimbursement, but coders such as Donna Howe with Anesthesiology Consultants of Eastern Connecticut in Manchester don't recommend it. Reasoning: "Aetna doesn't pay for post-op pain control, and they have told us we may not add the insertion time," she says. "It might be an individual carrier issue, but we find that trying to add the time messes up our concurrency program, so we don't do it."

If the physician placed the catheter for post-op management after the procedure, you can report 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) for the first day's care. Append modifier -59 (Distinct procedural service) to show that this catheter placement and management are separate from the surgery. Adequately Document Medical Necessity When you append modifier -59 to 62319, be sure to include documentation for the post-op block.
 
"Our local Medicare carrier wants only one diagnosis code, so we don't include the diagnosis for the original surgery," [...]