Add G89.18 to Your Surgical Claims for Post-Op Pain Management
Question: I code surgical procedures for an outpatient facility. I have an operative note that states the surgeon administered a nerve block during surgery to assist with postoperative pain management. The nerve block isn’t for chronic pain, just post-op pain. What diagnosis code should I use to report the nerve block? Massachusetts Subscriber Answer: You’ll want to explore the G89.1- (Acute pain, not elsewhere classified) code subcategory to locate the correct post-op pain management code. In your case, we recommend using G89.18 (Other acute postprocedural pain). This code features the additional diagnosis terms postoperative pain not otherwise specified (NOS) and postprocedural pain NOS, which makes it the correct choice for showing the medical necessity for the pain block. You mentioned in your question that the surgeon performed the nerve block during the surgery. According to the 2025 Medicare National Correct Coding Initiative (NCCI) coding policy manual, chapter 2, when the surgeon administers the nerve block during the procedure, the pain management portion is included in the global package. However, if the surgeon requests that an anesthesiologist administers the nerve block during the procedure, then the surgeon’s documentation must reflect the request, and the anesthesiologist should document the request in a separate procedure note and that the work was for post-op pain management. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
