Anesthesia Coding Alert

Question: Medicare is denying our claims for postoperative pain management because we're filing with an improper diagnosis. What ICD-9 diagnoses will they accept for post-op pain management?

Maryland Subscriber

Answer: You can submit a pain diagnosis ICD-9 code for the epidural or block for post-op pain as long as the anesthesia provider places the catheter or block for pain management instead of using it to deliver anesthesia during the procedure.

Some carriers have very specific guidelines for acceptable post-op diagnoses, so check your carrier's local medical review policies (LMRP) for a complete list. (For example, Medicare in New York only reimburses for code V58.49 [Other specified aftercare following surgery] in these situations.) Possibilities could be general codes such as V58.49 or codes specific to the surgery, such as 719.46 (Other and unspecified disorders of joint; pain in joint; lower leg) for knee surgery. Many carriers accept 958.8 (Other early complications of trauma) to support medical necessity for post-op pain management. You can use this code to report early signs of trauma complications, such as compartment syndrome resulting from nerve and tendon compression.

Carriers frequently require separate pain diagnoses for the patient's original condition and his or her post-op treatment because anesthesia providers give pain therapy for a different reason than they administer the original anesthesia. For example, a patient having gallbladder surgery under general anesthesia could have an initial diagnosis of 574.20 (Calculus of gallbladder without mention of cholecystitis) and a postoperative diagnosis of 789.07 (Abdominal pain; generalized) to justify a lumbar epidural for pain management.

However, remember that while knowing a carrier's acceptable diagnoses for a situation is helpful, you still need to code based on the individual case and the supporting documentation.