Pre-op Blocks for post-op pain

rogerseg

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Does anyone know if you can generate two claims in an ASC - one for the block and one for the procedure?
 

dbybee

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Does anyone know if you can generate two claims in an ASC - one for the block and one for the procedure?
We have been generating 2 claims for the procedure and block but BC/BS is now refusing to pay our claims unless they are on the same claim form. You might check with your payers to see if they will pay them separate.
 

Mary Krohn

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We usually code the procedure using the ASA code and the post op pain block using the CPT code with a 59 modifier. Both codes are getting reimbursed. Blue Cross has not been paying for the pain block but is negotiating with anesthesiologists around the country to try and come up with some agreement.
 

rogerseg

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Because some payors only pay on the first line item. The block is done by a different provider than the provider who performs the procedure and is also done in a different setting, i.e. holding unit vs. OR
 

mbort

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The setting in which the procedure took place should not affect your claim since as an ASC you should be using the POS code 24, however I can relate to wanting to document in your system for the two different providers (especially if they are both investors)

You can use two seperate claim forms however the problem with this is that the pre-op and post op blocks will require a modifier 59 (even though they clear all edits, they are denied by carrier thinking that the block is the primary anesthesia which it is not).

Hope this helps :)
Mary
 

rogerseg

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Mary

I have a couple of more questions:

1. what about submitting the one claim only....with only the surgeon on the claim form and submitting only his name as performing the blocks .....when he did not.

2. Should the payers - if billed on one claim form with modifier 9 - if they only allow 3 lines for CPT's should the 59 indicate separate procedure and be paid at 100% if billed this way....

Thanks for any help you can offer.
 

mbort

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Hi Roger

1. You are technically billing a facility fee for the ASC not for the physicians. If you were billing for the physicians then yes, seperate claim forms are appropriate. (Think of it this way...you have a surgeon and an asst surgeon..you dont put both of them on your claim form, but both submit charges, same with co-surgeons doing separate procedures at the same time).

2. Thats a tough one to answer--that is strictly dependent on your contracts with the carriers. The majority of carriers use the multiple procedure reduction (100/50/25)

Hope this helps :)
Mary
 
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