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Close the Door on Post-Op Claims Returns

Published on Tue Feb 08, 2005

Check these areas if they keep coming back

If your post-op pain management claims are returning unpaid, it's time to confirm that you're following all of the carrier's guidelines. Be sure you can check off these necessary items:

  • You have the request in writing.

  • You have reported the correct type of service (TOS).

  • There is clear documentation of the catheter placement.

  • You have identified whether the carrier has a limit to the number of post-op days allowed (many cap this at three days).

  • You have verification of whether you're coding for PCEA or PCA.

  • You are only reporting post-op management once per day, even if more than one physician checks on the patient during the day.

  • Your primary diagnosis is pain, not the reason for the initial surgery.

    "Our most common reason for denial is that the post-op care is included in the anesthesia service - even when we've appended modifier -59 (Distinct procedural service)," says Donna Howe, a coder with Anesthesiology Consultants of Eastern Connecticut in Manchester. "Getting surgeons in the habit of putting their request for post-op pain control in writing can help you code correctly and receive reimbursement."

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