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post op pain codes

  1. #1
    Default post op pain codes
    Medical Coding Books
    I work for an Anesthesia office and we are getting denied for cpt code 76942-26 due to dx. The code is paired with a nerve block such as 64415 for post op pain. The dx codes we use for both are ex; G89.18 & M75.101 (acute post procedural pain and chronic rotator cuff tear right shoulder). Any thoughts on dx code that would better pair with the 76942-26.


  2. Default post op pain and 76942
    No idea if this will be any help at all - it appears to be quite a sticky wicket! (note - u will have to translate ICD 9 to ICD 10 in the excerpt below) Best of luck!

    If ultrasound guidance is utilized and appropriately documented, CPT code 76942 [Ultrasound guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation] may be reported separately with a -26 modifier (if applicable). Documentation of the use of ultrasound alone is not sufficient —according to CPT Non-obstetrical ultrasound coding guidelines, “Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable.” A retrievable image should be available, along with a procedure note describing the use of ultrasound for placement of the block. It is also important for anesthesia coders to remember that codes obtained from the surgery and radiology section are flat-fee and, although no time is reported separately, documentation must support the time the block was placed (i.e. 7:21 to 7:34) to clearly indicate that it was separate from the reported anesthesia time when applicable. Reporting daily management of postoperative pain will vary, depending on the services provided. According to the NCCI, “CPT code 01996 may only be reported for management for days subsequent to the date of insertion of the epidural or subarachnoid catheter.” CPT 01996 would not be reported for other types of continuous catheters, such as CPT codes 64416, 64446, or 64448. Coders should determine whether the documentation supports an Evaluation and Management (E&M) service, including the chief complaint (related to postoperative pain) and at least two of the three required elements for subsequent hospital care (History, Examination, and Medical Decision Making). Keep in mind that if the surgeon has transferred responsibility for postoperative pain management to an anesthesia provider, only one physician or qualified healthcare professional should report these services. Acute pain diagnosis codes are separately identified in the 338 section of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), although there has been some confusion regarding reporting a diagnosis code from this section. According to ICD guidelines, “Routine or expected postoperative pain immediately after surgery should not be coded.” However, the guidelines also state that “If pain control/management is the reason for the encounter, a code from category 338 should be assigned as the principal or first-listed diagnosis” and “may be reported as the principal or first-listed diagnosis when the stated reason for the admission/encounter is documented as postoperative pain control/management”. As routine pain management is provided by the surgeon, it is my opinion a category 338 code
    21. The Communiqué TABLE 2 Diagnoses Supporting Medical Necessity for Postoperative Pain Management (Noridian) ICD-9CM 338.11 338.12 338.18 338.19 ICD-10- Description CM G89.11 Acute Pain Due to Trauma G89.12 Acute PostThoracotomy Pain G89.18 Other Acute Postoperative Pain R52* Other Acute Pain (*Pain Unspecified) should be reported when anesthesia is requested to provide POPM. Note in Table 2, published in the final Noridian LCD, category 338 is recognized in the list of ICD 9 codes that support medical necessity. Since ICD-10 isn’t too far away, the table has been updated to include these conversion codes. Historically, anesthesia practices have relied on documentation by the anesthesia provider to support the surgeon’s request for POPM, such as a procedure note or anesthesia record indication of the surgeon’s request. In the current environment, coders rely on W i n t e r 2014 the documentation guidelines as outlined in the NCCI and the recommendations listed by the ASA. Documentation in the medical record must support the surgeon’s transfer of care and this requirement means that anesthesia practitioners should request written, rather than verbal, communication. According to Dr. Peter Dunbar, who serves on the Noridian CAC for Washington State, standing orders from surgeons will be acceptable as long as they are both surgeon and procedure specific. Resources American Society of Anesthesiologists (ASA) Relative Value Guide® (2013) Reporting Postoperative Pain Procedures in Conjunction with Anesthesia (Pages 58 – 65)


  3. #3
    Thank you for replying. That information helps some but still not sure if I should put different dx code for the 76942-26.

  4. Default both dx codes are coming back denied?
    Have you tried adding modifier 59? This article talks about when a separate charge for pre, intra or post surgical nerve block is billable and how to code for it.


    85% denial reported since Jan. 2016. Mass confusion!


  5. Default post op pain codes
    We bill the 76942-26 with a 59 mod. Diagnosis's we use are G89.18, then Pain should. We also use that diagnosis with the block code.

    Alicia, CPC

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