Anesthesia Coding Alert

Question: Our anesthesiologist administered a patient's acute pain block for postoperative pain management while he medically directed a case in another room. Can we bill the post-op block separately?

New Mexico Subscriber
  
Answer: A few carriers have published guidelines that allow physicians to administer acute pain blocks or perform other services while medically directing other cases. Check your carrier's guidelines on the issue before submitting the claim.
 
Carriers such as First Coast in Florida and Connecticut and TrailBlazer in Colorado, Maryland and Texas (and many other states) allow these extra services (such as addressing an emergency of short duration, administering an epidural or caudal anesthetic for labor, and receiving patients into the OR suite).
 
Even if your carrier allows additional services, ensure that your physician meets all the criteria for medical direction before billing the case as such:
 
• Performing a pre-anesthetic examination and evaluation
 
• Prescribing the anesthesia plan
 
• Personally participating in the most demanding aspects of the anesthesia plan, including induction and emergence
 
• Ensuring that any procedures in the anesthesia plan that he does not perform are performed by a qualified individual
 
• Monitoring the course of anesthesia administration at frequent intervals
 
• Remaining physically present and available for immediate diagnosis and treatment of emergencies
 
• Providing indicated postanesthesia care.

He must meet the Seven Rules of Medical Direction, or you must code the case as medically supervised instead (with modifier AD, Medical supervision by a physician: more than four concurrent anesthesia procedures; instead of modifier QY, Medical direction of one certified registered nurse anesthetist [CRNA] by an anesthesiologist; or QK, Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals).
 
Note: Placing a block for postoperative pain relief seems similar to the other "allowed" services while medically directing, but don't assume your carrier allows for it. Check with your carrier before including it with your physician's allowable services.