Wiki POSTOPERATIVE PAIN BLOCKS

[adam@somnexanesthesia.com]

Good morning,

We have recently started billing for our own anesthesia services. It looks like Medicare is separating the claim, and rejecting the postop pain blocks.
We are utilizing the 59 modifier, the anatomic modifier for side (LT or RT) and are writing a description of the block, specifying that it is requested by the surgeon for postop pain.

These are the denial descriptors:

MA15 Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
N211 Alert: You may not appeal this decisionM52 Missing/incomplete/invalid “from” date(s) of service.
N345 Date range not valid with units submitted.


Does anyone have any insite into this?

Thanks!

 

[tec76]

So, for Medicare, try reporting the XU modifier instead of the 59 modifier. I would also recommend that block note documentation states that the block was ordered (rather than merely requested) by the surgeon due to the anesthesiologist’s expertise in performing blocks, or something to that effect. Medicare requires documentation of the reason the surgeon is asking anesthesia to do it. See Chapter II of the NCCI Manual for more details.

 

[adam@somnexanesthesia.com]

So, for Medicare, try reporting the XU modifier instead of the 59 modifier. I would also recommend that block note documentation states that the block was ordered (rather than merely requested) by the surgeon due to the anesthesiologist’s expertise in performing blocks, or something to that effect. Medicare requires documentation of the reason the surgeon is asking anesthesia to do it. See Chapter II of the NCCI Manual for more details.

Thank you so much. I will try this and let you know if I was successful.

 

[lschock79]

We have been getting many more post op block denials from EVERYONE. Right now we are getting VERBATIM of the NCCI edit back from the payor saying basically that post op blocks are an inherent part of the global surgical package so the onus is on the surgeon to document WHY they are not able to perform the post op block and the kicker here is they say IT SHOULD BE A RARITY. I have a feeling we will see policies in general change in the next 5 years to post op blocks by anesthesia not being paid period. Our surgeons currently do not document enough to get this extra payment.

 

[adam@somnexanesthesia.com]

We have been getting many more post op block denials from EVERYONE. Right now we are getting VERBATIM of the NCCI edit back from the payor saying basically that post op blocks are an inherent part of the global surgical package so the onus is on the surgeon to document WHY they are not able to perform the post op block and the kicker here is they say IT SHOULD BE A RARITY. I have a feeling we will see policies in general change in the next 5 years to post op blocks by anesthesia not being paid period. Our surgeons currently do not document enough to get this extra payment.

View attachment 6805

It's really too bad for the patients. Medicare will then be paying for readmission for pain control afterwards. I guess I'll stop doing them until they decide to pay.