# Post-op pain days for a Continuous nerve block



## missyah20 (Jan 6, 2011)

Good Morning,
  I have a CRNA who is doing some continuous femoral nerve blocks for his patient's.  The procedures are done in an ambulatory surgery center.  The patient's are sent home with the catheter and a pump.  The CRNA then does follow-up by calling the patient to get the numbers from the pump, ect.   Can we bill for these follow-up telephone calls? 

Thanks!


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## dwaldman (Jan 8, 2011)

98966-98968 do have a CPT Assistant article but 99441-99443 does here is some thing from that. I looked on the Medicare Fee Schedule and they have around twelve dollar reimbursement even though they have this other thing that says 

Case Management Services (Codes 99362 and 99371 - 99373)
A. Team Conferences

Team conferences (codes 99361-99362) may not be paid separately. Payment for these services is included in the payment for the services to which they relate.
B. Telephone Calls

Telephone calls (codes 99371-99373) may not be paid separately. Payment for telephone calls is included in payment for billable services (e.g., visit, surgery, diagnostic procedure results).

Below is all that I could find on CPT Assistant


Year: 2008 

Issue: March 

Pages: 6-7 

Title: Coding Communication: Non-Face-To-Face Physician Services: Telephone Services 

Body: Medical care has traditionally been considered a face-to-face service provided in the office, hospital or nursing facility, patient's home, or clinic setting. Due to advancements in communication technology and social change including patient empowerment, the need to provide greater access to care and chronic disease management have challenged the traditional face-to-face care paradigm, expanding the ways in which patients engage with their physicians and other healthcare providers. The Institute of Medicine report,Crossing the Quality Chasm(2001), envisions a patient-centered, responsive care-delivery system that leverages technology to transform care from a visit-based approach to one that is a continuous healing relationship in which the patient exercises greater control in the processes of care. To this end,CPT 2008has established a new section, Non-Face-to-Face Physician Services, that includes a Telephone Services subsection.

Codes 99441-99443 were established to describe telephone services initiated by the patient, parents or guardian and provided by a physician to an established patient via telephone. They represent non-face-to-face evaluation and management services provided by the physician to an established patient that do not lead to a related office visit. Communications with the office staff, whether they do or do not end in an office visit, are not reported by these codes. When the physician initiates regular telephone communications to patients, family, or guardians as a component of care management for one or more chronic illnesses, the Care Plan Oversight Services codes (99374-99380) should be reported.

Conditions and Guidelines

   • The telephone service is initiated by an established patient, parent, or guardian of an established patient. If a physician is covering after hours for a colleague with whom the patient has an established doctor-patient relationship, the covering physician may be considered to have an established relationship with the colleague's patient or guardian.

   • If the telephone service ends with a decision to see the patient within 24 hours or the next available urgent visit appointment, a telephone service code is not reported. In this instance, the telephone encounter is considered part of the preservice work of the subsequent E/M service, procedure, and visit.

   • If the telephone call is in reference to an E/M service performed and reported by the physician within the previous seven days (either physician requested or unsolicited patient follow-up) or within the postoperative defined global period of a previously completed procedure, then the telephone service is considered part of that previous E/M postservice work and should not be reported separately.

   • The telephone E/M service codes are now distinguished by the length of the medical discussion with the patient, parent, or guardian rather than the complexity of the conversation utilized in the deleted 99371-99373 codes.

      99441       Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

      99442              11-20 minutes of medical discussion

      99443              21-30 minutes of medical discussion


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## mitchellde (Jan 9, 2011)

The key to the 99441-99443 is that it must be inititated by the patient.  You say the CRNA does the followup by calling the patient, so therefore these codes will not apply.


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