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ASC pain management with surgery

  1. Default ASC pain management with surgery
    Medical Coding Books
    Here is my deliuma. I have an anesthesiologist who is preforming a post op pain block in the pre operative setting with an order from the surgeon prior to surgery. Pt is taken to the OR. The operative report reads block given by anesthesia in the pre operative area. In my opinion this is part of the surgery. The powers that be state its two different dr's two different locations unbundle the codes and bill for the surgery and the pain management injection. What do you think?

  2. #2
    I agree with you. If the block is for the part of the body that is being operated on, it is part of the anesthesia and cannot be billed separately. You can always refer to the federal register showing that anesthesia is part of the asc's reimbursement. I would be interested to know of any asc's that are separating the charges and if they are getting any payments for it.

  3. #3
    I recently went to an ASC seminar (Nove 2007) that stated that these can be billed seperately, both an ASC facility fee and the anesthesia can bill for it (ie scalene block) IF the block is in addition to the anesthesia used in the OR (ie general, mac) and the anesthesia doctor either dictates an official note or the facility has some sort of a form type document that they fill out and sign for the chart.

    from cpt assistant:

    Title: Anesthesia and Postoperative Pain Management

    Body: Coding Clarification

    The following article builds on information originally presented in the February 1997 CPT Assistant article, "Anesthesia: Coding for Procedural Services."

    Codes for procedures commonly used in the management of postoperative pain include 62318 and 62319 (both introduced in CPT 2000) for continuous epidural analgesia and the series of codes for somatic nerve blocks (64400-64450).

    It is appropriate to report pain management procedures, including the insertion of an epidural catheter or the performance of a nerve block, for postoperative analgesia separately from the administration of a general anesthetic.

    When general anesthesia is administered and these injections are performed to provide postoperative analgesia, they are separate and distinct services and are reported in addition to the anesthesia code. Whether the block procedure (insertion of catheter; injection of narcotic or local anesthetic agent) occurs preoperatively, postoperatively, or during the procedure is immaterial.

    If, on the other hand, the block procedure is used primarily for the anesthesia itself, the service should be reported using the anesthesia code alone. In a combined epidural/general anesthetic, the block cannot be reported separately.


    A patient having total knee replacement surgery may receive a regional anesthetic and a postoperative pain management agent through the same epidural catheter, in which case the only code reported would be 01402.

    A femoral nerve block (64450) placed to provide post-operative analgesia for an anterior cruciate ligament repair or a total knee replacement would be reported separately from the surgical anesthesia.

    A patient undergoing a thoracotomy might receive an epidural injection of a local anesthetic and/or narcotic (62318) for postoperative pain control in addition to the general anesthetic, which is administered through an endotracheal tube (00540). In this case, the epidural is not the surgical anesthetic and it would be reported separately, as an independent procedure.

    Shoulder surgery could be performed under an interscalene brachial plexus block that would also provide postoperative analgesia. This would be reported using the anesthetic code (eg, 01620). If the block were intended primarily to alleviate postsurgical pain, and a general anesthetic was administered for the shoulder procedure, the block would be separately reportable using code 64415.

    A brachial plexus block might also provide both the anesthesia and the postoperative pain control for an open reduction of a wrist fracture. Only the anesthesia code would be reported.

  4. #4
    I have been coding anesthesia for three years. We were told that POPM can be coded in addition to the anesthesia code, but it had to state post op. We modify 59 the POPM.

  5. Post 401.9 question
    Hi i have a question re: coding outpt hosp. Pt's BP is controlled by meds. Triage nurse circles HTN on admit sheet And there is a Hx of BP meds listed in EHR. Do you code 401.9 and CC or only CC? Guidelines state if pt is on BP meds even if no sign of high BP currently it must be coded as 401.9 . This can alter the state the way a pt is treated.y

  6. #6
    I have a question regarding pain management surgery. In the cpt cd book it stated that the fluro is included in the service. For examples 64483 includes the guidance. We are an out of network provider and they have previously been billing 77002 TC. Is this appropirate or should we only be billing the cpt 64483 without the imaging?

  7. #7
    77002 is included in the description for code 64483, so it should not be billed separately. By the way, you should really post new questions in a new topic, not as a comment on an existing topic :-)
    Walker Bachman, CPC, CPPM

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