Anesthesia Coding Alert

Question: Can we separately bill for postoperative pain management services by the anesthesiologist?

Texas Subscriber

Answer: Postoperative pain management services by an anesthesiologist, such as an injection or catheter insertion into the epidural space or major nerve, are eligible for separate reimbursement, as long as the block or catheter was not used as an adjunct to anesthesia provided for the surgery or as the mode of anesthesia.

Remember the following points while coding for post operative pain management:

• When postoperative pain management services are performed bilaterally, the unilateral code must be reported once with modifier 50 (Bilateral procedure) using the applicable base value for the unilateral code.
• A bilateral pain management code may be considered as one surgical service and may be eligible for reimbursement equal to 150 percent of the maximum allowance for the code.
• An epidural or major nerve injection or catheter insertion performed by an anesthesiologist for postoperative pain management before, during, and/or following the surgical procedure is eligible for separate reimbursement in addition to the primary anesthesia code. You may append modifier 59 (Distinct procedural service) or one of the new X modifiers to the appropriate procedure code to indicate a distinct procedural service was performed.
• The daily management of epidural drug administration (01996, Daily hospital management of epidural or subarachnoid continuous drug administration) for postoperative pain management performed by the anesthesiologist is eligible for reimbursement one time per date of service subsequent to the surgery date.

Caveat: However, when the daily management code is reported on the same day as an anesthetic injection code such as epidural injections 62310 or 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid …), or continuous epidural infusion or bolus 62318 or 62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid), only the injection code is eligible for reimbursement.