# Injections for postoperative pain



## maine4me (May 31, 2012)

I need help with some HCPCS codes for the following injections.  A patient came in to see our general surgeon for her postoperative pain.  At the first visit he gave her an injection of 3cc of lidocaine and 4cc of bupivacaine(marcaine). At the follow up visit he gave her 3cc of marcaine and 3 cc of lidocaine, plus 2.5 cc of kenalog.  For the kenalog I have J3301, however I am at a loss for the lidocaine and the marcaine/bupivacaine.


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## JMeggett (Jun 1, 2012)

So "post-operative injection for pain"...is this still in the Global period?  It's my understanding that this is not billable.  This below excerpt was posted by someone on an Orthopaedic board I'm a member of:

_Any routine followup, consisting of an office visit, a surgical procedure performed in the office due to POSTOPerative complications, or admission and follow up E/M in the hospital, should not be billed as a separate service. These services are considered to be included in and part of the GLOBAL service period of the surgical procedure. 

Examples: Status post knee surgery: The patient returns with increased pain and swelling. Physician performs an ARTHROCENtesis. Both the E/M visit and procedure code 20610 are included in the POSTOPerative fee."

Claims Processing 100-04 Chapter 12 Section 40: "6. Staged or Related Procedures Medicare also states MODIFIER 58 is for therapy following a DIAGNOSTIC surgical procedure: "MODIFIER 58 can be used when a second surgery is performed in the POSTOPerative period of another surgery when the subsequent procedure was:

Modifier “-58” was established to facilitate billing of staged or related surgical procedures done during the POSTOPerative period of the first procedure. This modifier is not used to report the treatment of a problem that requires a return to the operating room.

The physician may need to indicate that the performance of a procedure or service during the POSTOPerative period was:

· Planned prospectively or at the time of the original procedure;

· More extensive than the original procedure; or

· For therapy following a diagnostic surgical procedure.

These circumstances may be reported by adding modifier “-58” to the staged procedure. A new POSTOPerative period begins when the next procedure in the series is billed."

Dec 2007 CPT Assistant: " Question: If a surgical arthroscopy of the knee is performed (29870-29889) and after withdrawal of the scope and portal suture the surgeon injects bupivacaine for POSTOPerative pain management directly into the knee joint, may code 20610 be reported in addition to the CPT code for the specific arthroscopic procedure performed?

Answer : Code 20610, Arthrocentesis, aspiration and/or INJECTION; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa), should not be reported when performed concurrent with another intra-articular procedure (eg, knee arthroscopy). However, should the bupivacaine INJECTION be performed at an anatomic site other than that of the knee arthroscopy, then the appropriate code from the 20600-20610 series should be reported, as appropriate, with modifier 59, Distinct procedural service, appended."_

It's also my understanding that "caine" drugs are not separately billable, just the Kenalog and 20610 in your case...if it's not still in the Global period.  The "caines" are included in the original procedure reimbursement.  Sorry to not give you happy feed-back! 
Jenna


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