Anesthesia Coding Alert

Question: Can you offer any advice on billing for nerve blocks for post-op pain control with a surgical procedure (such as knee surgeries, hysterectomies, shoulder or hip procedures, lower arm and hand procedures)? Is it legal so far as Medicare rules are concerned to bill for a surgical procedure and a nerve block for pain control? Also, is it legal to bill for a 62274 (intrathecal narcotic) for pain control with an abdominal surgery, hip surgery, or knee or foot surgery?

Cecelia McWhorter, Comp One Services Ltd.
Oklahoma City, Ok.

Answer: Usual postoperative PACU pain care is included in the anesthesia fee. The surgical global fee includes routine postoperative pain control. In order to bill separately for a pain service, it has to be unusual. For example, if all colectomies receive post-op epidurals it would not be special and would not be compensated by Medicare. If ordering an epidural for post-op pain (code 62319) is not routinely done, then this extra additional service could be reimbursed. For instance, you should be able to bill for this if anesthesia services are requested after the patient is released from surgery and moved to a room. If the block is administered while the patient is still in the OR, the services are considered bundled.

Some basic rules to keep in mind for this situation are: 1) if the service is standard procedure, it is already covered in the standard global surgical fee; 2) if it is not a usual service that the surgeon can provide, a request for consultation and the reason for the anesthesia service should be documented; 3) the block (whether it is a spinal epidural or a shoulder or femoral block) must be placed and used solely for post-op pain management. If you use the block to obtain any part of the anesthetic, then the placement of that block is included in the anesthesia fee.

An epidural (code 62319) placed for post-op only can usually be billed. However, if epidural anesthesia was a component of anesthetic care, then placement of the block was part of the anesthetic and cannot be billed again. Code 62274 was deleted in CPT 2000. Instead, you report using either code 62310 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], or diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or code 62311 (the same procedure as 62310, except in the lumbar, sacral region). If you bill for abdominal surgery, the anesthesia was entirely general, and the surgeon has documented a request for this exceptional intervention, then it should be compensated (depending on your local Medicare carriers policies).

Coding the procedure this way is legal; it is not illegal to bill for a service honestly coded and provided. It may not be compensated, or on review you may be required to repay money, but you are operating legally if you do not bill abusively or fraudulently. If you bill 62310 or 62311 for a procedure done under spinal anesthesia but make it look as if a separate procedure was done, then you might have a fraud and abuse problem. Some coders say that some Medicare carriers will deny payment for nerve blocks for post-op pain no matter when they are administered, so be sure to check with your local carrier about it.