# CRNA Pain Management & Noridian Medicare



## missyah20 (Mar 28, 2011)

Good Afternoon, 
Is there anyone out there billing for CRNAs doing pain management such as Facet Injections, ESIs, etc in a State covered under Noridian Medicare since they stated they will no longer pay CRNAs for pain management procedures?

If so, just curious how it is affecting you?


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## dwaldman (Mar 28, 2011)

Are the CRNAs seeing patients that they are not providing anesthesia for? 


https://www.noridianmedicare.com/cg...L&tmpl=part_b_viewnews&style=part_ab_viewnews
Medicare Part B
CRNA Practice and Chronic Pain Management 
Certified Registered Nurse Anesthetists (CRNAs) may provide anesthesia and related services to Medicare patients consistent with their State scope of practice and training and privileges: hospital, Ambulatory Surgical Centers (ASC) or office as appropriate. In a like fashion, these practitioners also may insert arterial lines and draw blood gases, place peripherally inserted central lines and central venous catheters (PICCs and CVPs) since formal guidelines and instructions as well as skills assessment are provided to CRNAs during their training.

Epidural injections are reimbursed as part of the anesthetic management of a patient and for the induction and maintenance of obstetrical analgesia. In addition, if the CRNA is an Advanced Registered Nurse Practitioner (ARNP) or Clinical Nurse Specialist (CNS), or working incident to a physician or Non-Physician Practioner (NPP), epidural injections may be reimbursed as part of the physician's or NPP's (NP, CNS, and PA) management of a patient with chronic pain.

Chronic Pain 
Chronic pain is the common symptomatic manifestation of a wide range of underlying medical conditions. Widely diverse injuries and medical illnesses may directly damage the peripheral and/or central nervous system and ultimately involve multiple body systems and manifest as chronic pain. Chronic pain induces or is accompanied by significant effects on mood, brain, neuroendocrine and other bodily systems' function. Reasonable treatment of the chronic pain disorder begins with a detailed medical assessment aimed at developing a diagnosis or diagnostic evaluation plan which will then lead to an appropriate and comprehensive therapeutic plan.

The comprehensive therapeutic plan may include interventional pain techniques, such as, epidural blockade. The assessment skills required for the evaluation of the chronic pain state and consequent therapy are not part of the CRNA training curricula. There are no guidelines or skills assessment available for development of the necessary medical diagnostic and therapeutic skills for CRNAs.



Posted: 3/17/2011


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