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ASC/Observation Facility

  1. #1
    Question ASC/Observation Facility
    Medical Coding Books
    We are an ASC that is going to be a 24 hour observation facility also. I have been asked if we can do post surgical pain management nerve blocks and get paid for this. I have no idea how to code this or even if I can. Help Please! Thanks Much

  2. #2
    Location
    Omaha, Nebraska
    Posts
    144
    Default
    I currently work for an ASC where all we do is primarily pain management. So, yes you should be able to get paid for pain management nerve blocks. What types were they thinking? We do epidurals, facets, radiofrequencies, SI joints, etc. You will need to watch your payers, however so you know the correct codes to submit. By this, I mean - if you use HCFA-1500 claim forms - you would just use the CPT code ... depending on the payer, you would add modifier -SG. Hope this helps!
    Carolyn Kohler, CPC
    Omaha, NE

  3. #3
    Default
    According to the Medicare NCCI manual anesthesia BLOCKs administered by anesthesia practitioners are not reportable if for a surgical procedure; however, if performed for pre-operative and/or post-operative PAIN MANAGEMENT, it may be reported separately if medically necessary. Although, there are NCCI edits when anesthesia BLOCKs are reported on the same date of service as anesthesia services, there are occasions when Medicare will permit the reporting of modifier -59 to indicate medically necessary post-operative PAIN MANAGEMENT that is unrelated to the procedure for which anesthesia was administered. The medical record documentation must support the reporting of modifier -59 under these specific circumstances.



    For further clarification and examples for reporting pre-op and POST operative PAIN MANAGEMENT, please review the NCCI Manual, link provided below.



    NCCI Policy Manual for Medicare Services, Chapter 2: http://www.cms.hhs.gov/NationalCorrectCodInitEd/

    In the December 2007 CPT Assistant it reference to a femoral nerve BLOCK performed by an anesthesiologist, which states that as long as the PAIN BLOCK procedure is intended to serve as a postoperative analgesia regimen and is not the primary anesthetic for the surgical procedure, it can be reported separately. Whether the BLOCK occurs preoperatively, postoperatively, or during the procedure is immaterial. Therefore, if there is an order, it meets medical necessity pre-operative BLOCKs and POST op PAIN BLOCK are separately reportable. Again, the patient's medical record must support a separate and distinct procedure was performed.

  4. #4
    Location
    Omaha, Nebraska
    Posts
    144
    Default
    I apologize for any confusion. That's what I get for assuming I knew what Diana was truly asking about. I wasn't looking at her question as purely "nerve BLOCKS". All of the pain management interventions we do are generally referred to as BLOCKS .. so, forgive me for not seeking further clarification prior to answering.
    Carolyn Kohler, CPC
    Omaha, NE

  5. Default
    Quote Originally Posted by DianaF View Post
    We are an ASC that is going to be a 24 hour observation facility also. I have been asked if we can do post surgical pain management nerve blocks and get paid for this. I have no idea how to code this or even if I can. Help Please! Thanks Much
    Diana,
    In our ASC the Anesthesiologist makes a separate dictation JUST for the post-operative pain nerve block given. We don't do the billing for the Anesthesiologist but I do bill out the nerve block code on our ASC facility claim with -59 & -SG. Some payors reimbursed and some didn't...so I started calling the ones that didn't and spoke to Provider Relations. Even with the nerve block CPT's on their fee schedules some carriers won't reimburse for them when billed with other CPT's. Check out your carriers' payment policy on nerve blocks. Alot of them have these on their websites.

    Jenna, CPC

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