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Post Op Pain Block

  1. #1
    Default Post Op Pain Block
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    Does anyone know the secret of getting paid in an ASC for post op pain block given by the Anesthesia service prior to the procedure using general anesthesia, For post op pain,,,,,

    I know Medicare won't pay. But insurance companies that we are contracted with should pay. Is it a matter of Apealing the denial and having to go that route everytime. It is all documented that Anesthesia did the block for the purpose of post op pain management....


  2. #2
    What procedure code are you talking about?...I have billed in the past a 20600 to private insurance and got paid.

  3. #3
    Philadelphia, PA
    Unfortunately, we will only get paid by WC and Auto claims. We include the OP report and we also have a specific form that states that the anes people did the POP block. I have heard in the past that maybe -59 would help on the block code with dx 338.18 . I cannot quote that source, but I do remember reading this in an ASC magazine.. Some of our commercial payors will pay as well, but it is scattered at best. Hope this helps.

  4. #4
    Ok here is what I learned...

    You don't want to use 338.18 because the pt. has not had the procedure yet to have the diagnosis of post operative pain. like you I read that article also and apparently you are not supposed to use that dx. Instead use a pain in limb, pain in joint, etc dx. and YES you use a 59 modifier to let the insurance company know that the anesthesia service did the block pre operatively specifically for post op pain.....along with billing the anesthesiologist on the claim and not the surgeon because the surgeon did not do the block.....It would still be the facility charge billing it with the facility tax id..... does this make sense. Anyone hear anything different or would like to add?

  5. #5
    We do the same. Except if it is documented that the block is done for post op pain we use 338.18.
    Teresa Wells, CASCC
    Crow Valley Surgery Center

  6. Default
    The ASC I work at uses 719.47 (foot pain) for all post op pain blocks, it sounds like 338.18 would be more appropriate, is anyone aware of any documentation that would support which diagnosis to use?

  7. #7
    No 338.18 is not appropriate unless the pain block is done after the procedure.

    The patient can't have a diagnosis of post operative pain if the procedure hasn't been done yet..... You are correct in using the pain dx's.

    If the pain block is done by anesthesia service after procedure then 338.18.

    If the pain block is done before procedure then pain dx......

  8. Thumbs down
    Blue Cross is now requiring both the charges for the acutual surgery and the post op pain block be billed on one claim form. Has anyone had this issue? Is this even possible?

  9. #9
    I never had a problem getting paid for those post op blocks for as long as the doctors will dictate a statement indicating they were not the ones providing the post op block and i always used the icd-9 related to the surgery. this is not a chronic pain
    Angelica Stephens RHIT, CPMA, COSC, CCS-P, CPC, COC.
    Albuquerque, NM

  10. #10
    Default Post Op Pain Block as a multiple procedure?
    We have the same situation that the Anesthesia provider provides the preop pain block. We use the pain in limb dx code and apply the modifier 59 although we are noticing that BCBS and UHC have been reducing the payment for the post op pain block under the multiple procedure guidelines. Since this is under the facility billing tax id and two different providers performing the surgery and the other the pain block should they be applying the multiple procedure reduction or should we be appealing this.

    Appreciate any help on this matter.

    Thank you,
    Theresa Diers
    Wausau, WI

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