Pain Management

Messages
1
Location
Appleton, WI
Best answers
0
Hello,

Below is part of a pain management procedure for stellate block and an IV regional block. My question is----should I be coding all of the "drugs" administered for the procedure? Since reimbursement isn't much for these drugs, the provider isn't worried about them being listed on the claim. I have a headache just thinking about this one. Any and all help is greatly appreciated.

Ex: using 2 mg of Versed and 10 mg of ketamine.
bupivacaine with 2 mg of Decadron was injected at this location.

50 cc of 0.5% lidocaine with 100 mcg of clonidine and 50 mg of Toradol



Procedure Note


Procedures:

1. Right stellate ganglion block.

2. Right upper extremity IV regional block.


Indication: CRPS.


Time Out: The patient’s name, site of procedure, allergies and anticoagulation status were checked and verified.


The patient was taken to the procedure room where he assumed supine position. The skin over the right side of the neck was prepped with ChloraPrep. Sterile drapes were placed. He had a 22-gauge IV started in the right upper extremity. IV sedation was provided using 2 mg of Versed and 10 mg of ketamine. Using a 22-gauge 3.5-inch needle, the junction between the C7 vertebral body and the uncinate process was accessed on the right side. Needle position at this location was confirmed by injection of 3 cc of Omnipaque-240 which revealed linear spread of the contrast along the longissimus coli muscle. 3 cc of 0.5% bupivacaine with 2 mg of Decadron was injected at this location.


At this point, the right upper extremity was exsanguinated using an Esmarch bandage. A right upper arm tourniquet was applied and inflated to 250 mmHg. 50 cc of 0.5% lidocaine with 100 mcg of clonidine and 50 mg of Toradol was injected through the IV in the right hand. The tourniquet was kept inflated for 30 minutes. Following deflation of the tourniquet, he was observed for approximately 20 minutes and was discharged home in stable condition. He is advised to return back to clinic in about a week for a repeat block. Total time spent on IV conscious sedation was 32 minutes.
 
I do bill the drugs used in the procedures. Most insurances do pay for steroids, sedations drugs, omnipaque, etc. Some do not. Some may have a small reimbursement but some pay well. If your provider performs a large amount of procedures it does add up.

Melissa Harris, CPC
The Albany and Saratoga Centers for Pain Management.
 
I also bill for the drugs used. In my experience, most of them pay less than 50cents, but the Toradol usually pays $1-2. I agree with Melissa, it isn't much per procedure (maybe $3 total depending on the insurance) but it can add up. Plus, once you've got the CPT and NDC codes down, it's not much more work to add them to the claims, especially if your billing system has an option for a quick click to add all of them at once.
 
Top