Anesthesia Coding Alert

You may have encountered problems in the past obtaining reimbursement for postoperative pain blocks. Often, payers will counter the claim by bundling pain blocks with anesthesia. Learn how to code these postop blocks for maximum effectiveness and avoid the whole appeals process.

"I always use one of the new acute pain diagnoses for my primary diagnosis, usually 338.18 (Other acute postoperative pain)," says Kay Brown, CPC, of Bayou Anesthesia and Pain in Spring, Texas. "For the secondary diagnosis I will use either pain in the joint (719.4X), if applicable, or V58.49 (Other specified aftercare following surgery)."

If the physician gives the block the same day as surgery, use a 59 modifier (Distinct procedural service) on the block, says Kathleen Zulick, BS, of the Department of Anesthesia at the Penn State Milton S. Hershey Medial Center. "We have our 'acute pain' physicians credentialed as a different specialty, and we use a different doctor number when we bill," she adds.

Brush up on CCI edits for 59: According to CMS, Correct Coding Initiative Edits (CCI) edits "define when two procedure HCPCS/CPT codes may not be reported together except under special circumstances. If an edit allows use of CCI-associated modifiers, the two procedure codes may be reported together if the two procedures are performed at different anatomic sites or different patient encounters."

Modifier 59 and other CCI-associated modifiers should not be used to bypass an CCI edit unless the criteria for use of the modifier is met. Again, the correct documentation in your anesthesiologist's medical record must satisfy the criteria required by any CCI-associated modifier used. To learn more about the ins and outs of modifier 59, visit http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf.

Additional 59 Resource: Check out the ASA publication regarding postop pain at http://www.asahq.org/publicationsAndServices/standards/43.pdf.

"Do your homework on the insurance company policies and your own insurance contracts," says Brown. "Know what is and is not allowed, either per your contract or the insurance company policy."

Remember, you also can negotiate your contracts. Look for any clauses regarding pain blocks, and see if they can be changed to your advantage. "Insurance carriers can dictate several options in their contracts -- especially anesthesia contracts -- depending on procedures rendered," Brown says. "Since insurance carriers know that anesthesiologists do a lot of post operative pain management procedures on the same day as a surgery before, during or after a main procedure, they may limit payment on some of them and/or bundle them into the anesthesia service. They may also make it their own policy not to allow payment on some of them."

Zulick agrees. "Whenever a contract comes up for renewal, we write a clause to include post operative pain management payments," she says.