# post-op pain block



## diann (Jun 18, 2010)

I have a case that I would like to know if I coded correctly for the ASC facility--still a little confused on the post-op pain block.  Any help would be greatly appreciated!
OP Report:

DX:Contracture status post revision knee arthroplasty, left knee with arthrofibrosis

Procedure: closed manipulation of lt knee under anesthesia

Description of Op: Pt brought to OR. General anesthesia administered. A femoral nerve block was placed afterwards(by the anesthesiologist).  Pt had gentle closed manipulation, which gave the pt 85 degrees initially of flexion, was gradually increased to 125 degrees by slight giving way of scar around quadriceps tendon.  Knee placed in full extension. Gentle hyperextension was applied getting back a few more degrees of extension. Pt brought to PACU.

I coded it:
DX: 718.56, V43.65
Procedure:27570-LT, 93.16

Here's my question would I add CPT code 64448-59 for the femoral block?
And would I use HCPCS code A4305 for the C-BLOCK pump?

I'm hesitant on the femoral block because there is just that one statement that it was done and there is no other documentation of it.

Thanks,
Diann


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## ASC CODER (Jun 18, 2010)

yes you post for the pain block because it was documented that the anesthesiologist administered it. 

I use 338.18 dx with the 59......


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## diann (Jun 18, 2010)

Thanks so much!  I just wanted to be sure.


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## mbort (Jun 21, 2010)

actually....I would not bill for the femoral block unless you have a report SPECIFICALLY from the anesthesiologist.  This was not the surgeons procedure therefore you should not be billing this under the surgeons name.  The anesthesiologist must have his own separate documentation of this block either via op note or block form.


hope this helps


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## delphinus777 (Jun 22, 2010)

I agree with MBORT.  To code this service you need to show it was separate from the anesthesia services as well. Here are some articles regarding this below.

http://www.beckersasc.com/coding-bi...ation-and-billing-of-post-op-pain-blocks.html

http://www.outpatientsurgery.net/issues/bbraun/5-top-tips-for-block-reimbursement

http://www.asahq.org/publicationsAndServices/standards/43.pdf

http://www.supercoder.com/articles/articles-alerts/aca/correctly-coding-for-post-op-pain-blocks/

http://e-ditionsbyfry.com/Olive/ODE...09/10/01&pageno=50&entity=Ar05000&view=entity


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## ASC CODER (Jun 23, 2010)

this is reported for the surgery center not under the surgeon.....When I answered the question I was saying for the FACILITY you can code for the pain block if administered by the anesthesiologist for pain management reasons only if done as part of the procedure than you can't.  I stand by my answer. Again this is for the FACILITY. I have found also most insurance companies (If contracted) will pay 2 to 3 hundred dollars for these post op pain blocks I don't know if you posted all of the operative note. It should be clear that it was given for Post op pain 338.18 and distinct from the procedure 59 modifier and administered by anesthesia usually in the notes I see "the block is given in pre op area by Anesthesia for post op pain." If the procedure warrents a General sedation then that would be all you need.


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