# Pain Management post op



## apulak (Feb 23, 2010)

I have a question.  A hospital wants my doctor to start an acute pain service at their hospital.  Before I say yes, I wanted to see if we get reimbursed with post surgical pain consults.  We will not be the physician performing the surgery. This hospital is a very heavy surgical hospital.  From what I know, the post op pain fee is bundled into the cost of the surgery.  Is this correct?  Is there a way around this?  What if we insist on seeing the patient prior to surgery?  Would it then be possible to get paid?  If we can't get reimbursed, is this true for both medicare AND private insurance?  

Thank you so much for your help


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## jreavis (Feb 23, 2010)

Will he be performing pain procedures, ie. blocks or continuous catheters.  You should be able to bill a pain consult to all but Medicare and maybe Medicaid, since Medicare doesn't reimburse consults any longer.  Make sure to use a pain diagnosis and not the surgical diagnosis.


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## hgolfos (Feb 24, 2010)

If your doc is managing the pts pain, first make sure that the surgeon has documented an order for post op pain management.  Medicare generally considers post op pain management to be the surgeon's responsibility.  The bypass of this is that the surgeon requests pain management from anesthesiology.  Second, obviously you can't bill consults for medicare, so choose the most appropriate inpatient E/M code.  Third, if you're doc is consulted specifically to give an injection and only for that reason only bill the injection.  As Jreavis above said, make sure to use the pain code as the primary diagnosis, and bill the dx for surgery as secondary.  Currently MC requires V58.49 for post op pain management, but effective March 1st you can use the newer acute pain codes 338.11-338.19.  Use the 338 series codes for other payers.  

Lastly, check with your specific payers to see how they cover different post op pain management procedures.  Many carriers do not cover IV/PCAs (Medicare is one of these) some cover only certain blocks.

Hope this helps.
HG


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