Wiki WPS & Post-op Pain blocks

[missyah20]

Good Afternoon,
I have been appealing my Ultrasound Guidance denials (code 76942) with WPS Medicare for the CRNA's in my group. Now recently I have received redetermination letters stating that no payment will be made for a post-op pain block performed before the surgery.

I know that Noridian has a draft policy stating this, but I have not seen anything come up with WPS.

Just wondering if anyone else has encountered this?

Thanks!

 

[dwaldman]

4. Under certain circumstances an anesthesiologist may separately report an epidural or peripheral nerve block injection (bolus, intermittent bolus, or continuous infusion) for postoperative pain management when the surgeon requests assistance with postoperative pain management. An epidural injection (CPT code 623XX) for postoperative pain management may be reported separately with an anesthesia 0XXXX code only if the mode of intraoperative anesthesia is general anesthesia and the adequacy of the intraoperative anesthesia is not dependent on the epidural injection. A peripheral nerve block injection (CPT codes 64XXX)for postoperative pain management may be reported separately with an anesthesia 0XXXX code only if the mode of intraoperative anesthesia is general anesthesia, subarachnoid injection, or epidural injection, and the adequacy of the intraoperative anesthesia is not dependent on the peripheral nerve block injection. An epidural or peripheral nerve block injection (code numbers as identified above) administered preoperatively or intraoperatively is not separately reportable for postoperative pain management if the mode of anesthesia for the procedure is monitored anesthesia care (MAC), moderate conscious sedation, regional anesthesia by peripheral nerve block, or other type of anesthesia not identified above. If an epidural or peripheral nerve block injection (code numbers as identified above) for postoperative pain management is reported separately on the same date of service as an anesthesia 0XXXX code, modifier 59 may be appended to the epidural or peripheral nerve block injection code (code numbers as identified above) to indicate that it was administered for postoperative pain management. An epidural or peripheral nerve block injection (code numbers as identified above) for postoperative pain management in patients receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or regional anesthesia by
epidural injection as described above may be administered preoperatively, intraoperatively, or postoperatively.

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Above is from the Medicare NCCI Policy manual. The final sentence in the paragraph indicate that it could be performed preoperatively.

 

[missyah20]

Thanks - I have that already to go so I have something to point to when I appeal their pulling back the payment on the post-op pain peripheral nerve blocks.