Anesthesia Coding Alert

Question: Our anesthesiologist administered anesthesia during the patient's surgical procedure and performed an injection for postoperative pain control. When I'm coding for the postoperative nerve blocks, are these procedures bundled into the anesthesia services?

Vermont Subscriber

Answer: The short answer is no. As stated in the AMA's April 2008 CPT Assistant, you may report any procedure that is performed solely to provide postoperative analgesia -- and isn't used to deliver anesthetic for a diagnostic or therapeutic procedure -- separately from your anesthesia service.

Your documentation should support that the anesthesiologist provided the services at the surgeon's request. According to the Correct Coding Initiative, "Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon."

How to code it: When your physician performs two distinct services on the same day -- such as placing a block for postoperative pain management on the same day as the anesthesia service -- you should append modifier 59 (Distinct procedural service) to the postoperative pain procedure code. This lets your payer know that the anesthesiologist didn't use the injection or block as the means for anesthesia but that it was separate and distinct.