# Joint injections for Post-op Pain?



## missyah20 (Nov 30, 2012)

Good Morning All,
  I have a CRNA from Arkansas who is asking about providing Joint injections for Post-op Pain relief.  

An example would be injecting the knee joint after an arthroscopic procedure for post-op pain control.  

I have not had any other providers use joint injections for pain control and my worry is that as a CRNA billing for codes 20600 - 20610 that the charge would be denied as provider not allowed to perform this service.  

Does anyone have any insight on this?

Thanks!


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## dclark7 (Dec 10, 2012)

My experience has been that the surgeon usually injects the joint at the close of surgery, and this of course is bundled with the surgery.  Sometimes the surgeon has requested the anesthesiologist do a nerve block to control post op pain, but this requires a request from the surgeon with the reason for doing it.


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## dwaldman (Dec 11, 2012)

Below is from the NCCI policy manual effective Jan. 1st 2013, it does mention CRNAs and states are payable if within the parameters of state liscensing laws. You mentioned a joint injection, which I believe could be rendered by the surgeon prior to closing. I do not believe it consitutes a "separate medically necessary service are required that cannot be rendered by the the surgeon" Additionally, they mention epidurals (62310-62319) and peripheral nerve blocks (64400-64530) as separately payable if the criteria is met. Nowhere do they mention they cover a joint injection provided by anesthesiologist or CRNA for post op pain management.



If permitted by state law, anesthesia practitioners may separately report significant, separately identifiable postoperative management services after the anesthesia service time ends. These services include, but are not limited to, postoperative pain management and

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.


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