Anesthesia Coding Alert

Question: One of our anesthesiologists is questioning the need to document the surgeon’s request and time spent placing post-op pain blocks or catheters. Can you explain why our coding department needs this information?

Michigan Subscriber

Answer: Coders depend on the documentation provided to properly report the anesthesiologist’s services. This is particularly important when trying to differentiate between anesthesia services provided for surgery and postoperative pain management (POPM) services to help control the patient’s pain afterward using techniques beyond the scope of the surgeon’s expertise.

According to the American Society of Anesthesiologists (ASA) Statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia, “a post-operative pain procedure may be reported as a service separate from the anesthetic if the post-operative pain procedure is employed primarily for post-operative analgesia” and if certain conditions apply (www. asahq.org/standards-and-practice-parameters/statement-on-reporting-postoperative-pain-procedures-in-conjunction-with-anesthesia).

One of these conditions is “the time spent on pre- or post-operative placement of a block is separated and not included in reported anesthetic time.” In order to determine whether this condition is met, coders must have documentation of anesthesia and procedural start and end times.

However, if a block is placed intraoperatively (after induction, before emergence), such as 64486 (Transversus abdominis plane (TAP) block …), you do not need to deduct block time from the reported anesthesia time.

Regarding the surgeon’s order, the ASA statement notes that “some payers may require documentation that the surgeon requested the anesthesia team to participate in the provision of post-operative analgesia. Some other payers may require that the surgeon’s request be documented by both the surgeon and the anesthesiologist.”

Bottom line: Your coding team needs documentation to support billing POPM as a separate service.

The ASA instructs you to see the Medicare Claims Processing Manual and National Correct Coding Initiative (NCCI) Manual for Medicare Services for more information.