Wiki Exparel billing in ASC question!

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
 
I work at an ASC ortho facility and we are currently billing Exparel with our totals when it is used. The op note includes how much was used and how much was wasted as does the claim.

'With the “allowed” payment status for C9290 and thus, separate reimbursement for EXPAREL, financial considerations or supply cost concerns to use EXPAREL on Medicare patients in an ASC are now eliminated. It also provides the necessary momentum for commercial payers to follow CMS policy, which is aimed at supporting the use of non–opioid-based postsurgical pain management in an ASC. For details and guidance on how to access Medicare reimbursement and engage your commercial payers, please visit www.EXPAREL.com/reimbursement. For additional information about reimbursement for EXPAREL, please contact 1-855-RX-EXPAREL (1-855-793-9727) or reimbursement@pacira.com.'

https://www.exparel.com/hcp/ASC_Payer_Negotiation_Guide_720_5071.pdf
 

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