# Pain Blocks - general anesthesia



## Barbara A. Love (Oct 14, 2015)

Scenario:  

Anesthesia provides a spinal block on a patient who is having a THR under general anesthesia.  The next day they do their post-op visit for the general anesthesia (separate note), but also evaluate the patient's block.  They want to bill an subsequent visit 99231 for the care of the block (pain control, is it working?) for which they will have a note.  

I am on the fence, anyone have any opinions?

Barbara Love, CPC, COC


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## dwaldman (Oct 14, 2015)

When you state they are evaluating the "patient's block" is that epidural catheter infusion that they are monitoring if so on postop day 1, that would be reported with 01996. Below is some additional information, notice it states if this is not monitoring epidural infusion but a post op pain management visit< it is stated:

"Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon.  The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner."

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html


Management of epidural or subarachnoid drug administration (CPT code 01996) is separately payable on dates of service subsequent to surgery but not on the date of surgery.  If the only service provided is management of epidural/subarachnoid drug administration, then an evaluation and management service should not be reported in addition to CPT code 01996.  Payment for management of epidural/subarachnoid drug administration is limited to one unit of service per postoperative day regardless of the number of visits necessary to manage the catheter per postoperative day (CPT definition).  While an anesthesiologist or non-medically directed CRNA may be able to report this service, only one payment will be made per day.  Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon.  The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner. In certain circumstances critical care services are provided by the anesthesiologist.  It is currently national CMS policy that CRNAs cannot be reimbursed for evaluation and management services in the critical care area.  In the case of anesthesiologists, the routine immediate postoperative care is not separately reported except as described above.  Certain procedural services such as insertion of a Swan-Ganz catheter, insertion of a central venous pressure line, emergency intubation (outside of the operating suite), etc., are separately payable to anesthesiologists as well as non-medically directed CRNAs if these procedures are furnished within the parameters of state licensing laws. 

 Pain management performed by an anesthesia practitioner after the postoperative anesthesia care period terminates may be separately reportable.  However, postoperative pain management by the physician performing a surgical procedure is not separately reportable by that physician.  Postoperative pain management is included in the global surgical package.  Example: A patient has an epidural block with sedation and monitoring for arthroscopic knee surgery.  The anesthesia practitioner reports CPT code 01382 (Anesthesia for diagnostic arthroscopic procedures of knee joint).  The epidural catheter is left in place for postoperative pain management.  The anesthesia practitioner should not also report CPT codes 62311 or 62319 (epidural/subarachnoid injection of diagnostic or therapeutic substance), or 01996 (daily management of epidural) on the date of surgery.  CPT code 01996 may be reported with one unit of service per day on subsequent days until the catheter is removed. On the other hand, if the anesthesia practitioner performed general anesthesia reported as CPT code 01382 and at the request of the operating physician inserted an epidural catheter for treatment of anticipated postoperative pain, the anesthesia practitioner may report CPT code 62319-59 indicating that this is a separate service from the anesthesia service.  In this       
 instance, the service is separately reportable whether the catheter is placed before, during, or after the surgery.  Since treatment of postoperative pain is included in the global surgical package, the operating physician may request the assistance of the anesthesia practitioner if the degree of postoperative pain is expected to exceed the skills and experience of the operating physician to manage it.  If the epidural catheter was placed on a different date than the surgery, modifier 59 would not be necessary.  Effective January 1, 2004, daily hospital management of continuous epidural or subarachnoid drug administration performed on the day(s) subsequent to the placement of an epidural or subarachnoid catheter (CPT codes 6231862319) may be reported as CPT code 01996.  ? 64400-64530 (Peripheral nerve blocks ? bolus i


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## Barbara A. Love (Oct 15, 2015)

No it is just a block.  patient had a hip replaced under general anesthesia and they were given a pain block in the spinal region (not used for anesthesia), no epidural so the 01996 doesn't come into play.  The day after surgery they would see the patient for their post-op check for the general anesthesia, but they are also assessing the block (how is your pain level, brief exam etc.).  they want to bill an low level subsequent hospital day code 99231 for evaluating the block.


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