# Post Op Pain Block



## ASC CODER (Feb 23, 2011)

Does anyone know the secret of getting paid in an ASC for post op pain block given by the Anesthesia service prior to the procedure using general anesthesia, For post op pain,,,,,

I know Medicare won't pay. But insurance companies that we are contracted with should pay. Is it a matter of Apealing the denial and having to go that route everytime. It is all documented that Anesthesia did the block for the purpose of post op pain management....


Anyone


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## elenax (Feb 25, 2011)

What procedure code are you talking about?...I have billed in the past a 20600 to private insurance and got paid.


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## SS62 (Feb 25, 2011)

Unfortunately, we will only get paid by WC and Auto claims.  We include the OP report and we also have a specific form that states that the anes people did the POP block.  I have heard in the past that maybe -59 would help on the block code with dx 338.18 .  I cannot quote that source, but I do remember reading this in an ASC magazine..  Some of our commercial payors will pay as well, but it is scattered at best.  Hope this helps.


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## ASC CODER (Feb 25, 2011)

Ok here is what I learned...

You don't want to use 338.18 because the pt. has not had the procedure yet to have the diagnosis of post operative pain. like you I read that article also and apparently you are not supposed to use that dx. Instead use a pain in limb, pain in joint, etc dx. and YES you use a 59 modifier to let the insurance company know that the anesthesia service did the block pre operatively specifically for post op pain.....along with billing the anesthesiologist on the claim and not the surgeon because the surgeon did not do the block.....It would still be the facility charge billing it with the facility tax id..... does this make sense. Anyone hear anything different or would like to add?


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## twells77 (Feb 28, 2011)

We do the same.  Except if it is documented that the block is done for post op pain we use 338.18.


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## ADenbesten1 (Mar 1, 2011)

The ASC I work at uses 719.47 (foot pain) for all post op pain blocks, it sounds like 338.18 would be more appropriate, is anyone aware of any documentation that would support which diagnosis to use?


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## ASC CODER (Mar 2, 2011)

No 338.18 is not appropriate unless the pain block is done after the procedure. 

The patient can't have a diagnosis of post operative pain if the procedure hasn't been done yet..... You are correct in using the pain dx's. 

If the pain block is done by anesthesia service after procedure then 338.18.

If the pain block is done before procedure then pain dx......


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## Awoll2006 (Jun 20, 2011)

Blue Cross is now requiring both the charges for the acutual surgery and the post op pain block be billed on one claim form.  Has anyone had this issue?  Is this even possible?


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## astephens (Jun 23, 2011)

I never had a problem getting paid for those post op blocks for as long as the doctors will dictate a statement indicating they were not the ones providing the post op block and i always used the icd-9 related to the surgery. this is not a chronic pain


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## tdiers (Sep 11, 2013)

*Post Op Pain Block as a multiple procedure?*

We have the same situation that the Anesthesia provider provides the preop pain block.   We use the pain in limb dx code and apply the modifier 59 although we are noticing that BCBS and UHC have been reducing the payment for the post op pain block under the multiple procedure guidelines.  Since this is under the facility billing tax id and two different providers performing the surgery and the other the pain block should they be applying the multiple procedure reduction or should we be appealing this.  

Appreciate any help on this matter.  

Thank you, 
Theresa Diers
BJOSC, LLC
Wausau, WI


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## drakena74 (Sep 12, 2013)

I work for an ASC in California. The following are the pain blocks our anesthesiologist perform:  64413, 64415, 64445, 64447. We have also done a few of the pain pumps as well.

The documentation on the Op report should state that the anesthesiologist performed a pain injections. on the anes. documentation it should stated that the surgeon requested the pain block.  Make sure the pain block documentation is seperate from the procedure anes. record.  If the surgeon peforms the block, you can't bill it seperately.

In our billing system, if we bill on paperclaim, unfortunately it gets printed on different claims form from the procedure, but this was never a problem getting paid.

we bill the above codes with modifier -59, -RT/-LT and with Dx 338.18.  We've never had a problem with getting paid from any of our carriers including BCBS out of state plans.  We don't bill Medicare because they don't pay.  Wokers' Comp is wishy washy. sometimes they pay, sometimes they don't. We still bill to them anyway.

As far as the 338.18 dx, i've gotten conflicting info on it. some say to bill 338.18 if injections given after procedure & 7xx.xx codes for before procedure. I've also heard we can bill 338.18 regardless of when injection was given. both info came from experienced coders.  

if you would like an example of how our anes. document the injections, just email me & I'll send a copy.

jdewitte74@gmail.com


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## tdiers (Sep 12, 2013)

Do any of your payors reimburse the pain block as a multiple procedure? We have noticed that BCBS and UHC have now started to do this and wondering if this is acceptable or if we can appeal.  

Theresa Diers
BJOSC, LLC


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## drakena74 (Sep 12, 2013)

tdiers said:


> Do any of your payors reimburse the pain block as a multiple procedure? We have noticed that BCBS and UHC have now started to do this and wondering if this is acceptable or if we can appeal.
> 
> Theresa Diers
> BJOSC, LLC


Sometimes they do, sometimes they don't. They can't seem to make up there minds how they want to pay it.  But most pay as a multiple procedure.

In California, Anthem BC & Blue Shield are seperate entities.  Per our BS contract they will only pay up to 2 lines.


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