Per Medicare Global Surgery rules, the physician performing an operative
procedure is responsible for treating postoperative pain. Treatment of postoperative pain by the
operating physician is not separately reportable. However, the operating physician may request
that an anesthesia practitioner assist in the treatment of postoperative pain management if it is
medically reasonable and necessary. The actual or anticipated postoperative pain must be severe
enough to require treatment by techniques beyond the experience of the operating physician. For
example, the operating physician may request that the anesthesia practitioner administer an
epidural or peripheral nerve block to treat actual or anticipated postoperative pain. The epidural
or peripheral nerve block may be administered preoperatively, intraoperatively, or
postoperatively. An epidural or peripheral nerve block that provides intraoperative pain
management is included in the 0XXXX anesthesia code and is not separately reportable, even if
it also provides postoperative pain management. (See Chapter II, Section B, Subsection 4 for
guidelines regarding reporting anesthesia and postoperative pain management separately by an
anesthesia practitioner on the same date of service.)
If the operating physician requests that the anesthesia practitioner perform pain management
services after the postoperative anesthesia care period terminates, the anesthesia practitioner may
report it separately using modifier 59 or XU. Since postoperative pain management by the
operating physician is included in the global surgical package, the operating physician may
request the assistance of an anesthesia practitioner if it requires techniques beyond the
experience of the operating physician.
