Outpatient Facility Coding Alert

Question: A patient returns two days following a rotator cuff repair (acute) complaining of chronic pain. The physician performs a suprascapular nerve block for pain management purposes. Can I code for this service?

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Answer: The global period for surgical code 23410 (Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute) is 90 days. Since the surgeon performs a 64418 (Injection, anesthetic agent; suprascapular nerve) within the original procedure's global period, you will have to adhere to Medicare global surgery guidelines in order to determine whether this procedure is billable.

Chapter VIII of the National Correct Coding Initiative (NCCI) Policy Manual states the following in respect to pain management following a surgery:

• "Medicare Global Surgery Rules prevent separate payment for postoperative pain management when provided by the physician performing an operative procedure. CPT^® codes 36000, 36410, 62320-62327, 64400-64489, and 96360-96377 describe some services that may be utilized for postoperative pain management. The services described by these codes may be reported by the physician performing the operative procedure only if provided for purposes unrelated to the postoperative pain management, the operative procedure, or anesthesia for the procedure."

Additionally, the Medicare Global Surgery Booklet includes "postsurgical pain management by the surgeon" as an inclusive component within the global surgery payment.

The same idea applies if and when the surgeon performs a suprascapular nerve block before performing the rotator cuff repair. Even without knowledge of the NCCI guidelines, you can get your answer by performing a simple NCCI edits check. You will see that these two procedures are mutually exclusive to one another, with 64418 being the column 2 code to 23410. Therefore, you will only bill out these two procedures together if the provider performs a nerve block beyond the 90-day global surgery threshold period.

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