Separately Bill Post-Op Pain Management Ethically
Published on Wed Aug 01, 2001
Billing for an anesthesiologist's postoperative services -- such as epidural analgesia, nerve blocks (a routine part of pain management beyond the surgical suite) and patient-controlled administration of analgesia -- frequently challenges coders and billers, because these procedures are sometimes bundled with the surgical payment. The key to reimbursement is coding these services so Medicare and private carriers recognize them as separate and distinct from services of other providers, such as the surgeon.
Coding Postoperative Consults
Cindy Parman, CPC, CPC-H, principal and co-founder of Coding Strategies Inc., a coding consulting firm in Dallas, Ga., says, "In general, payers consider the operating surgeon as providing the postoperative pain management and many make it part of the global surgical payment. Other carriers, however, allow separate reimbursement when the surgeon requests in writing that the anesthesiologist offer advice or manage the patient's in-hospital postoperative pain."
Scott Groudine, MD, an anesthesiologist in Albany, N.Y., says, "If the anesthesiologist is requested to evaluate pain management of a patient in the hospital after surgery, and has not performed the operative anesthesia , 99251 (initial inpatient consultation for a new or established patient) is the most commonly used code for the initial in-patient consultation. This is because most patients require only a problem-focused evaluation. Codes 99252-99255 (initial inpatient consultation for a new or established patient) might also be suitable, depending upon the level of care, complexity of the examination, and degree of medical decision-making. As with any E/M service, the three key elements (history, examination and medical decision-making) must be documented in the patient's medical record.
"However," Groudine adds, "if a member of the anesthesia group provided services for the patient's surgery, and a consult on the same day, then append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M codes to distinguish it from other procedures performed that day."
As stated in CPT 2001, if, subsequent to the completion of the consultation, the consulting anesthesiologist assumes responsibility for management of a portion or all of the patient's condition(s), you would not use the follow-up consultation codes. In the hospital setting, the physician should use the appropriate inpatient hospital-consultation code for the initial encounter and then subsequent hospital-care codes, 99231-99233.
Post-Op Pain-Management Procedures
Epidural Pain Management
In the postoperative period, hospital in-patients who have had major surgical procedures such as hysterectomy, spinal arthrodesis or radical nephrectomy might be continuously infused with pain medication through an epidural catheter.
The anesthesiologist can bill for placing a catheter intended for postsurgical [...]
