Wiki NERVE BLOCK NOTE

[mkndevh@msn.com]

Hello. Does anyone have any information on a possible change to CMS documentation requirements for the "Reason for block" on a post-op nerve block note? We're hearing that CMS may not be accepting post-op pain management "per surgeon request" anymore. Thank you.

 

[lschock79]

Right now Medicare is cracking down on post op pain blocks paid through anesthesia services. Per CMS guidelines "postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that CANNOT be rendered by the surgeon. The surgeon is RESPONSIBLE to document in the medical record the reason care is being referred to the anesthesia provider." In other words the surgeon cannot just state "requested for postoperative pain". They are wanting to see two things: 1)an order for the block from the surgeon and 2) A specific reason why the care is being transferred ie difficult anatomy etc. Right now the onus is on the surgeons for anethesia to be able to get paid for this. However this could also be a flag for medicare in paying these as well....if EVERY surgeon is documenting difficult anatomy it's going to look like a copy/paste scenario. Per Medicare anesthesia services providing the postoperative pain blocks should be a "rare" occurrence. We also all know that when Medicare starts something most of the big commercial payors follow so I predict withing 2-3 years we will see these not being paid by others.