POST-OPERATIVE PAIN MANAGEMENT / POST-OP PAIN BLOCKS:
Purpose: In general, a “pain block”/ “pain injection” is given for 2 purposes:
A)Main anesthesia / TOA.
B)Post-op. pain control.
However a single pain block sometimes may work for BOTH the above purposes.
- Blocks used for BOTH PURPOSES (Surgical Anesthesia + Post-op pain) are not reported separately (because it is the TOA). Only the ASA code is reported (surgical purpose).
- Blocks are billable, IF ONLY administered by any ASA staff. It’s non-billable, if administered by any other doctor, viz. by a surgeon.
- Look for 3 sets of information BEFORE CODING A POST-OP BLOCK [code the post-op block when BOTH conditions satisfy] -
- Provided by ASA staff [not by a surgeon]
- Pupose is post-op pain control. [and NOT surgical anesthesia]
- A distinct and separate TOA is available/given.
TIME for P.O. block administration is NOT important – it can be given PRE-OP / INTRA-OP / POST-OP time. INTENT/PURPOSE is all important. A post-op block can easily be given pre-operatively, and still is billable.
Blocks are mostly encountered in cases like ORIF, other procedures on joints/arthroscopies, often encountered with circulatory system procedures (carotid endarterectomy), laparotomies, nephrectomy, etc.
Documents/Record requirement: A) Either ASA record ; OR, B) Peripheral nerve Block sheet.
BLOCKS THAT ARE NOT REPORTED BY CODERS: Mayo block / Field block / Retro-Bulbar Block (RBB) / Peribulbar Block (PBB) / Bier Block (in post-op).
P.O. BLOCK CODES:
1) Epidural / Spinal à 62320 – 62327 (62320-62323 – single shot ; 62324-62327 – continuous catheter)
2) Perpheral à 64401 – 64450 ; 64455
3) TFE (Trans Foraminal Epidural) à 64479 – 64484
4) MBB / Median Branch Block / Facet Joint Injection à 64490 – 64495
5) TAP block à 64486-64489
5) “Other” peripheral SS post-op block (when there is no specific CPT code for a peripheral nerve S.S . block) à 64450
6) “Other” peripheral C.C. (Cont. Cath.) post-op block (when there is no specific CPT code for a peripheral nerve block) à 64499
7) Report BLOCK 19 note in case of reporting 64450 / 64999 -<code number> <nerve block name> <single shot or continuous>. Do NOT put any punctuation mark [protocol available in generic protocol]
Use of 01996 ASA code for DAILY MGT. of post-op pain blocks:
Scenario:
On the day of main surgery - ASA service (00100-01999) + P.O. epidural/spinal CONT. CATH. Block (62324 – 62327)
From NEXT DAY ONWARD - If ASA staff gives daily pain injection through the existing catheter (look for terms like “Bolus / dosage info / drug name Bupi/Ropi etc.”) à report 01996 one unit each day.
If ASA staff simply visits the Pt. to evaluate and leaves, without giving any pain injection, -report EM Inpatient subsequent visit code 99231.
01996 can come only from the NEXT day of the DOS of the main surgery, and only if a code from 62323-62327 has been reported on the main DOS.
On the day of main surgery -ASA service (00100-01999) + P.O. Peripheral Nerve CONT. CATH. Code (64999 / 64416 / 64448 etc.)
From NEXT DAY ONWARD -If ASA staff gives daily pain injection through the existing catheter (look for terms like “Bolus / dosage info / drug name Bupi/Ropi etc.”) OR,
If ASA staff simply visits the Pt. to evaluate and leaves, without giving any pain injection, - report EM Inpatient subsequent visit code 99231.
TOA MAC + Post-op BLOCK (BPS specific rule):
Report MAC TOA with ASA code (00100 – 01999) + report P.O. Block code with mod 59, LT/RT/50.
ULTRASOUND:
US guidance with BLOCKS - 76942 – mod 26
US guidance with line placements - 76937 – MOD 26
When US guidance is given with BOTH block and Line placement within the same chart, report only 76937-mod 26. Do NOT report 76942-mod 26.
DIFFERENCE BETWEEN ANESTHESIA CODING AND PAIN MANAGEMENT CONCEPT:
Whoever (physician) performs whichever service – gets paid/reimbursed only for that part. No physician should submit a bill for any part of the service which s(he) did not perform.
Any diagnostic/therapeutic/surgical service involves 2 parts of service -A) surgery/diag./therapy ; B) Anesthesia. SURGERY is the main service always.
1)SURGEON does the surgery – gets paid for surgery.
ASA STAFF does anesthesia – gets paid for anesthesia. - this is Anesthesia coding.
2)If ASA STAFF does SURGERY + ANESTHESIA both – gets paid for the surgery; Anesthesia is NOT separately billable by anyone. à this is Pain Management coding.
ANESTHESIA CODING: When providing anesthesia is the MAIN SERVICE done by the ASA staff. The same physician may also perform some ancillary service/additional services including post-op pain block, which are secondary. Surgical part is done by a different provider (so a separate surgeon is available).
Patient’s reason for visit à to get a surgery done. As per requirement, anesthesia is given (any TOA) by ASA staff to help the surgeon.
ASA record should be available, with other documents. Surgical OP report done by the surgeon may also be present.
PAIN MANAGEMENT CODING: When providing pain treatment is the MAIN SERVICE done by the ASA staff. These are mostly pain injections given directly by the ASA staff. No separate “surgical part” involved. NO SURGEON IS INVOLVED. ASA staff acts like a surgeon + provides anesthesia. Anesthesia provision is NOT reported separately. Only main service is reported, as done by the ASA staff.
Patient’s reason for visit à to get pain treatment from the anesthesia staff physician only.
ASA record is usually not available as providing anesthesia is not the main service done by ASA staff. OP report (for providing the pain injection) done by the ASA staff may be available.
Lets’ take 3 examples.
BLOCKS THAT ARE NOT REPORTED BY CODERS: Mayo block / Field block / Retro-Bulbar Block (RBB) / Peribulbar Block (PBB) / Bier Block (in post-op).
P.O. BLOCK CODES:
1) Epidural / Spinal à 62320 – 62327 (62320-62323 – single shot ; 62324-62327 – continuous catheter)
2) Perpheral à 64401 – 64450 ; 64455
3) TFE (Trans Foraminal Epidural) à 64479 – 64484
4) MBB / Median Branch Block / Facet Joint Injection à 64490 – 64495
5) TAP block à 64486-64489
5) “Other” peripheral SS post-op block (when there is no specific CPT code for a peripheral nerve S.S . block) à 64450
6) “Other” peripheral C.C. (Cont. Cath.) post-op block (when there is no specific CPT code for a peripheral nerve block) à 64499
7) Report BLOCK 19 note in case of reporting 64450 / 64999 -<code number> <nerve block name> <single shot or continuous>. Do NOT put any punctuation mark [protocol available in generic protocol]
Use of 01996 ASA code for DAILY MGT. of post-op pain blocks:
Scenario:
On the day of main surgery - ASA service (00100-01999) + P.O. epidural/spinal CONT. CATH. Block (62324 – 62327)
From NEXT DAY ONWARD - If ASA staff gives daily pain injection through the existing catheter (look for terms like “Bolus / dosage info / drug name Bupi/Ropi etc.”) à report 01996 one unit each day.
If ASA staff simply visits the Pt. to evaluate and leaves, without giving any pain injection, -report EM Inpatient subsequent visit code 99231.
01996 can come only from the NEXT day of the DOS of the main surgery, and only if a code from 62323-62327 has been reported on the main DOS.
On the day of main surgery -ASA service (00100-01999) + P.O. Peripheral Nerve CONT. CATH. Code (64999 / 64416 / 64448 etc.)
From NEXT DAY ONWARD -If ASA staff gives daily pain injection through the existing catheter (look for terms like “Bolus / dosage info / drug name Bupi/Ropi etc.”) OR,
If ASA staff simply visits the Pt. to evaluate and leaves, without giving any pain injection, - report EM Inpatient subsequent visit code 99231.
TOA MAC + Post-op BLOCK (BPS specific rule):
Report MAC TOA with ASA code (00100 – 01999) + report P.O. Block code with mod 59, LT/RT/50.
ULTRASOUND:
US guidance with BLOCKS - 76942 – mod 26
US guidance with line placements - 76937 – MOD 26
When US guidance is given with BOTH block and Line placement within the same chart, report only 76937-mod 26. Do NOT report 76942-mod 26.
DIFFERENCE BETWEEN ANESTHESIA CODING AND PAIN MANAGEMENT CONCEPT:
Whoever (physician) performs whichever service – gets paid/reimbursed only for that part. No physician should submit a bill for any part of the service which s(he) did not perform.
Any diagnostic/therapeutic/surgical service involves 2 parts of service -A) surgery/diag./therapy ; B) Anesthesia. SURGERY is the main service always.
1)SURGEON does the surgery – gets paid for surgery.
ASA STAFF does anesthesia – gets paid for anesthesia. - this is Anesthesia coding.
2)If ASA STAFF does SURGERY + ANESTHESIA both – gets paid for the surgery; Anesthesia is NOT separately billable by anyone. à this is Pain Management coding.
ANESTHESIA CODING: When providing anesthesia is the MAIN SERVICE done by the ASA staff. The same physician may also perform some ancillary service/additional services including post-op pain block, which are secondary. Surgical part is done by a different provider (so a separate surgeon is available).
Patient’s reason for visit à to get a surgery done. As per requirement, anesthesia is given (any TOA) by ASA staff to help the surgeon.
ASA record should be available, with other documents. Surgical OP report done by the surgeon may also be present.
PAIN MANAGEMENT CODING: When providing pain treatment is the MAIN SERVICE done by the ASA staff. These are mostly pain injections given directly by the ASA staff. No separate “surgical part” involved. NO SURGEON IS INVOLVED. ASA staff acts like a surgeon + provides anesthesia. Anesthesia provision is NOT reported separately. Only main service is reported, as done by the ASA staff.
Patient’s reason for visit à to get pain treatment from the anesthesia staff physician only.
ASA record is usually not available as providing anesthesia is not the main service done by ASA staff. OP report (for providing the pain injection) done by the ASA staff may be available.
Lets’ take 3 examples.
1)Patient comes for HIP SURGERY. Gets GA anesthesia. Surgeon does the surgery. ASA staff performs GA + also post-op S.S. ESI injection -coder gets ASA record, surgeon’s OP report. Coder reports ASA code + ESI with mod 59. This is anesthesia coding.
2)Patient comes for ESI s.s. injection for chronic lumbar pain. Gets MAC anesthesia. Surgeon provides the ESI injection. ASA staff performs TOA. - coder gets ASA record, surgeon’s injection procedure report may or may not be found. Coder reports ASA code 01991 / 01992 . This is anesthesia coding.
3)Patient comes for ESI s.s. injection for chronic lumbar pain. No surgeon is available. Only the ASA staff is available. He applies MAC anesth. + also does the pain injection service (ESI) which is the main procedure during the visit. - coder does NOT get ASA record, only procedure note for ESI (written by ASA staff) is available. Since there is no surgeon available, and ASA staff has only played the role of a surgeon, he gets paid for the surgical service (ESI performance). So separate payment is NOT made for MAC anesthesia. Coder reports direct CPT 62323 (Flat Fee).
2)Patient comes for ESI s.s. injection for chronic lumbar pain. Gets MAC anesthesia. Surgeon provides the ESI injection. ASA staff performs TOA. - coder gets ASA record, surgeon’s injection procedure report may or may not be found. Coder reports ASA code 01991 / 01992 . This is anesthesia coding.
3)Patient comes for ESI s.s. injection for chronic lumbar pain. No surgeon is available. Only the ASA staff is available. He applies MAC anesth. + also does the pain injection service (ESI) which is the main procedure during the visit. - coder does NOT get ASA record, only procedure note for ESI (written by ASA staff) is available. Since there is no surgeon available, and ASA staff has only played the role of a surgeon, he gets paid for the surgical service (ESI performance). So separate payment is NOT made for MAC anesthesia. Coder reports direct CPT 62323 (Flat Fee).
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