Question Exparel billing for ASC

cherylbr

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Please help clear up a question on correct billing for Exparel in an ASC and provided by either the Surgeon or Anesthesiologist.

We are billing for the facility on this.

Are there only certain procedures (CPT codes) that allow for the billing in combination with Exparel code C9290?

Here is the snip from the Exparel manufacturer which is quite confusing:

EXPAREL is indicated for single-dose infiltration in adults to produce postsurgical local
analgesia and as an interscalene brachial plexus nerve block to produce postsurgical
regional analgesia. Safety and efficacy have not been established in other nerve blocks.
The infiltration indication includes regional field, or interfascial plane blocks, such as, but
not limited to, transversus abdominis plane (TAP) block, pectoralis (PEC) and serratus
plane blocks, erector spinae plane (ESP) block, thoracolumbar interfascial plane (TLIP)
block, interspace between the popliteal artery and capsule of the posterior knee (iPACK),
and quadratus lumborum (QL) block.


How do you interpret this? Is C9290 only to be billed in conjunction with interscalene brachial plexus nerve block usage? Is it appropriate to bill C9290 in conjunction with interfascial plane blocks, such as, but not limited to, transversus abdominis plane (TAP) block, pectoralis (PEC) and serratus plane blocks, erector spinae plane (ESP) block, thoracolumbar interfascial plane (TLIP) block, interspace between the popliteal artery and capsule of the posterior knee (iPACK),
and quadratus lumborum (QL) blocks as well?

In most cases our facility's anesthesiologist is providing it for post op pain on total knee replacements with block codes 64447, 64999 (I-pack) block, & occasionally 64445. Again we are billing for the facility.

Also, what documentation is needed when the anesthesiologist provides the Exparel? Does this need to be on the operative note or is documentation within the anesthesia record enough documentation?

Please give me your input and/or understanding on this as I am very confused and need direction ASAP.

Thank you!
Cheryl
 

fwnewbie

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If your facility didn't provide it, you can't bill for it. Where did the anesthesiologist get it? Who paid for it? I don't like to see random medical supplies wandering into an operating room without some kind of paper trail to document exactly where it came from.
When a doctor uses a medication in a way not described on the product insert, it is considered "off label" but in this case, the statement "infiltration indication includes regional field, or interfascial pain blocks, Such As, But Not Limited To".... covers basically any regional block usage. Whether the insurance company will pay and how much is up to the policy.
 

cherylbr

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If your facility didn't provide it, you can't bill for it. Where did the anesthesiologist get it? Who paid for it? I don't like to see random medical supplies wandering into an operating room without some kind of paper trail to document exactly where it came from.
When a doctor uses a medication in a way not described on the product insert, it is considered "off label" but in this case, the statement "infiltration indication includes regional field, or interfascial pain blocks, Such As, But Not Limited To".... covers basically any regional block usage. Whether the insurance company will pay and how much is up to the policy.
The facility is purchasing it and is keeping a paper trail to document this information. Do I understand this correctly per your response that it can be billed with any regional block? (transversus abdominis plane (TAP) block, pectoralis (PEC) and serratus plane blocks, erector spinae plane (ESP) block, thoracolumbar interfascial plane (TLIP) block, interspace between the popliteal artery and capsule of the posterior knee (iPACK), and quadratus lumborum (QL) blocks as well?
Also, where can I find this information to supply to my supervisor?
Thank you so much for this valuable information that I much needed.
Have a wonderful day!
Cheryl
 

fwnewbie

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Read that paragraph from the supplier carefully: Infiltration indication INCLUDES regional field, or interfascial pain blocks, SUCH AS, ...
Wherever you got that info, maybe from the insert that comes with the medication, will help your supervisor make a decision as to how to handle this drug. The insert only provides the usage guidelines -how your facility and the insurance companies choose to bill is their decision.
And I'd like to remind you, I am not an experienced coder or biller. I am an RN with a COC-A behind my name and came to this conclusion using only critical thinking from the info you provided.
 
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