# Acute Pain Block / Anesthesia Question



## TammyW (Nov 5, 2010)

We have just went live with an anesthesia EMR that time stamps everything that was done.   

I'm working on this case that was documented 0709-0927,
then I get to the Acute Pain case that was time stamped that it was placed at 0719 by the provider working on the anesthesia case.

I have a problem telling the insurance carrier that this provider was committed to the anesthesia case ... and then submit a flat fee pain charge ... it feels like double billing, of sorts, to me.

I can not find any articles that reference this situation ... And maybe I'm way off here ... Can somebody please advise.


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## dwaldman (Nov 5, 2010)

https://www.cms.gov/NationalCorrectCodInitEd/

Look at chapter two in the NCCI Policy Manual. It gives examples of two scenarios. They describe if the operating surgeon requests of the anthesiologist to provide the placement of epidural catheter soley for post operative pain management and they are stating this can be done pre, intra, or post surgery and reported with the 59. But they state if the catheter is placed for intraoperative pain control and it is also going to be used for post operative pain control then it is not separately reportable. I hope my intrepretation and recount of what they were stating is correct and clear. There is also descriptions of the coding for this in the CPT Assistant archives.


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## ohiocoder101 (Nov 6, 2010)

anesthesia emr... do you like it? i do coding for several anesthesia groups and if there is an eletronic record for this particular speciality, i will be so happy. i am tired of the unreadable handwritting, missed diag & procedure codes., did it cost alot? if you do not want to discuss on here, please send me a private message. would really love to present this to my boss.

thanks


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## TammyW (Nov 8, 2010)

THANK YOU for the policy reference ... that is exactly what I needed.


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## dwaldman (Nov 8, 2010)

Here is article from AMA CPT Assistant 2001 I did not read thru thoroughly enough to make sure that everything is current but I noticed what they are saying is similiar to the NCCI policy manual.

Anesthesia and Postoperative Pain Management

The following article builds on information originally presented in the February 1997 CPT Assistant article, "Anesthesia: Coding for Procedural Services." 

Codes for procedures commonly used in the management of postoperative pain include 62318 and 62319 (both introduced in CPT 2000) for continuous epidural analgesia and the series of codes for somatic nerve blocks (64400-64450). 

It is appropriate to report pain management procedures, including the insertion of an epidural catheter or the performance of a nerve block, for postoperative analgesia separately from the administration of a general anesthetic. 

When general anesthesia is administered and these injections are performed to provide postoperative analgesia, they are separate and distinct services and are reported in addition to the anesthesia code. Whether the block procedure (insertion of catheter; injection of narcotic or local anesthetic agent) occurs preoperatively, postoperatively, or during the procedure is immaterial. 

If, on the other hand, the block procedure is used primarily for the anesthesia itself, the service should be reported using the anesthesia code alone. In a combined epidural/general anesthetic, the block cannot be reported separately.


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