Anesthesia Coding Alert

Question: Our anesthesiologists use ultrasound guidance when placing nerve blocks for post-operative pain control (sciatic/femoral/etc.). Since January, CMS has been denying about 85 percent of our claims for ultrasound guidance (we submit 76942-26). Some of our appeals have resulted in the claim being reprocessed, but Medicare’s decision on most remains unfavorable. CMS states “The service was denied because the information provided did not support the need for this service.” Our anesthesia notes include a regional block section, which contains a copy of the ultrasound guidance photo. What steps should we take next? What is our best solution?

Colorado Subscriber

Answer: Your first step is to verify that you have a written request from the surgeon asking your anesthesiologist to provide post-op pain management care. Once this request is in place, check to see that you are reporting two different diagnosis codes. This is because you’re coding for two different procedures (the original surgery and the postoperative care) for two different reasons.

The primary diagnosis should tie into the reason for the surgery and anesthesia. The secondary diagnosis will be for the pain management; report G89.18 (Other acute postprocedural pain) for this.

Also: Track back the diagnosis codes being reported and checking whether some are denied more often than others.