New to Pain management

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Modesto, CA; Central Valley Chapter
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It's been a very long time since I was involved in pain management. I thought that somewhere I had read that for cpts such as 64417 when done by an anesthesiologist who is not acting as a pain specialist would receive the 8 base units.

But where the 64417 is being done by Pain management then it is one unit and reimbursed based on RVUs.

Does this make sense?
Thanks
Tina, CPC
 

dwaldman

True Blue
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Although the relative value guide provides a base unit for nerve blocks. Reimbursement methodlogy for nerve blocks is not based on time divide by fifteen plus base units times the coversion factor.
 

hgolfos

Guru
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Montgomery, Alabama
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Tina,

If your physician is providing anesthesia for the nerve block that another physician is performing you would bill the anesthesia code, not 64417, with base units plus time. This would be unusual as this type of block does not normally require anesthesia, so make sure you code the underlying condition that justifies the anesthesia and then code to the most accurate ASA code. The 2012 crosswalk crosses 64417 to 01991 3 base units.

If your physician is actually doing the block there are no "base units." instead you have a quantity of 1. Your code is billed as a flat fee with type of service 2 (surgery). You can check with your payers to see what they reimburse for the procedure and decide from there where to set your billed amount.

Hope this helps.
 
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