# Pre-emptive pain injections



## coderguy1939 (May 11, 2009)

I recently read that Medicare will not pay for Pre, intra-operative or post operative (immediately after completion of surgery before patient is taken to recovery) pain injections if administered by the surgeon.  I can't remember where I read this--I think it might have been Anesthesia Coding Alert.  Does anyone have any info on this?  Thanks.


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## jdrueppel (May 11, 2009)

Coderguy,

I don't know where you read it recently but NCCI does outline that postoperative pain management is not separately billable by the surgeon.

Julie, CPC


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## mbort (May 11, 2009)

I know this is true for 20610..I think its in the NCCI guidelines as well.  Is this the code you are referring too?  If so, shoot me an e-mail at work and I will forward you an e-mail about it.


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## coderguy1939 (May 11, 2009)

Hi Mary,

No, this is regarding nerve blocks which I should have indicated in my original post.  I'm with Julie on this one regarding the surgeon not being able to bill for this service.  Can an anesthesiologist bill for this service if requested by the surgeon?


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## jdrueppel (May 11, 2009)

Yes, the anesthesia provider can bill for blocks if they are not used for the mode of anesthesia and appropriately documented "per surgeon request for postoperative pain".  You will most likely need to add the -59 modifier to the block charge if you are also billing for the anesthesia service.

Julie, CPC


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## NIENAJADLY (May 12, 2009)

*Pre-emptive blocks*

Please be aware that at least in Florida, our Medicare carrier came out with an LCD change that states that neither the surgeon NOR the anesthesiologist who does a procedure can bill for preemptive blocks.  You can have another provider come in to do it but there needs to be very specific and good reasons for that to happen.  We just saw it discussed in the Anesthesia & Pain Coders Pink Sheet May 2009.  The LCD is effective 2/2/09.


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## coderguy1939 (May 14, 2009)

Thanks for all the input.  I thought I read that restriction on both the surgeon and the anesthesiologist in the Anesthesia Alert but I can't find it.


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## NIENAJADLY (May 15, 2009)

*Lcd link*

http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=29258&lcd_version=3&show=all 

If you copy/paste the above link and then click accept once you get to the CMS website, it'll bring you to the LCD.  The changes are very subtle and basically buried in the LCD.  The first time it shows up, just explaining the preemptive block is under 7B of "Indications and Limitations" but the kicker is past the approved dx list under Documentation Requirements.  Hope this helps.


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## coderguy1939 (May 15, 2009)

Thanks for the LCD info.  I checked my FI's LCD and the language is a bit more ambiguous but heading in the same direction.  Thanks again.


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## NIENAJADLY (Jul 16, 2009)

*Pre-emptive blocks ***update****

We recently found per a letter from NCCI to the ASA that these edits are going to be removed and retroactive back to April 1, 2009.  *This won't be implemented until the 10/1/09 update so you can either bill out the blocks, wait for any denial, then appeal after 10/1/09 or keep track of the ones you have and wait to bill it out until after the update in October.

Hope this helps.

Kellie


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