Anesthesia Coding Alert

Master these global-period rules for cleaner claimsThe one thing you always need to establish is medical necessity -- and a post-op femoral block procedure is no exception. Our experts give you the scoop on what you need to know when you consider billing for post-op visits.Here's How You Can Avoid Stumbling on the BlockConsider this example: Your pain management specialist inserts a catheter for a continuous femoral block for acute post-op pain management for a patient on long-term opioids who had an open reduction internal fixation (ORIF) for a distal femur fracture. Then your physician tells you that he did post-op "rounds" on the patient for two days to monitor the continuous infusion."Assuming the services are provided by the anesthesiologist, all of the experts are in agreement that as long as the continuous infusion is not used as the mode of anesthesia for the surgery, the pain management procedure should be separately billable," says Pamela Linton, CPC, anesthesiology coding specialist with Medical Management Professionals, in Chattanooga, Tenn.-"If the catheter for the femoral block was inserted at the time of surgery, we would bill it out as 64448 (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) using modifier 59 (Distinct procedural service) with diagnosis code 338.18 (Other acute postoperative pain)," says Kelly Dennis, MBA, CPC, ACS-AP, with Perfect Office Solutions of Leesburg, Fla. You can find more information on category 338 at http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm.Code 338.18 tip: The ICD-9 guidelines specifically state that acute postoperative pain diagnosis codes cannot be reported for routine or expected postoperative pain immediately after surgery. In this scenario, the patient potentially won't have the routine or expected pain levels because of potential narcotic tolerance due to long-term use for another condition.Post-Op Visits Go Global"There is a 10-day global period associated with 64448," Dennis says. That means "no other related services should be billed in that time frame when a continuous femoral infusion is used for post-op pain management," she says.According to CPT: The code descriptor for 64448 includes "daily management for anesthetic agent administration." You only charge for the initial continuous infusion service -- the 64448 charge includes any subsequent E/M services directly related to the original procedure.Lesson: You should not report routine post-op visits for 64448 separately.Reminder: All the continuous infusion codes in the 64405-64450 range have 10-day global periods. These include 64448, 64416 (... brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration), 64446 (... sciatic nerve, continuous infusion by catheter [including catheter placement], including daily management for anesthetic agent administration) and 64449 (... lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily [...]