Anesthesia Coding Alert

Tip: Remember modifier 59 is your friend.

You've been busy applying new and revised procedure or diagnosis codes, but don't forget the coding guidelines associated with CPT Codes;, HCPCS Codes, or other sources. Case in point: The 2012 Correct Coding Initiative (CCI) coding guidelines include information about reporting post-operative pain management that your anesthesia providers will need to know. Read on for details, thanks to a guideline analysis from Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner of Precision Auditing and Coding.

Check Timing and Clarify Purpose

Medicare global surgery rules specify that the surgeon performing the procedure is responsible for post-op pain management and should not report the care separate from the surgery. The rules change, however, when the surgeon asks the anesthesiologist or pain management specialist to handle the patient's post-op treatment.

Before requesting an anesthesiologist's help, the "actual or postoperative pain must be severe enough to require treatments beyond the experience of the operating physician," CCI guidelines state. For example, the surgeon might request that the anesthesiologist place an epidural or nerve block to treat the patient's post-op pain.

Remember: The anesthesiologist might choose to place the epidural before, during, or after the surgery. You can only code the service, however, if the line for the epidural or nerve block is not also used for anesthesia administration during surgery. If it is, you should only report the appropriate anesthesia code for the surgery and not separately code for post-op management.

When you can legitimately report the post-op management, look at coding options such as:

• 62310 or 62311" Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid ...
• 62318 or 62319 -- Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid ...
• 64400-64530 -- Introduction/injection of anesthetic agent (nerve block), diagnostic or therapeutic procedures on the extracranial nerves, peripheral nerves, and autonomic nervous system.

Append modifier 59 (Distinct procedural service) to indicate that the anesthesiologist placed the nerve block or epidural for post-op management instead of intraoperative anesthesia. Remind the anesthesiologist to include a procedure note in the patient's record documenting the block's purpose.

Watch Details of Post-Global Help

The surgeon might sometimes request pain management services after the postoperative anesthesia care period ends. You can code for this situation without worrying that the care might be misinterpreted as part of the surgical anesthesia. However, CCI guidelines clarify that you still should append modifier 59 to the appropriate code for pain management services.