Wiki assistance with a case

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jsecor

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I am needing some direction or assistance with the following case:

Patient has a total knee replacement 27447
continuous femoral nerve block 64448
ultrasound guidance 76942
IT duramorph 01996
PCA-1day 96374
SAD - subarachnoid block? (1st time seeing this)
femoral c-block? (also 1st time seeing this)

I am thinking all these blocks are great and wonderful but what about the patient, aren't they still awake and would you still do a knee replacement with just the listed above blocks?

I'm just a bit confused and yes ALL are listed on the Anesthesia Record. I am thinking that the provider forgot to mention he used General anesthesia for the Total Knee Replacement. From what I can tell is the SAD - subarachnoid block/intrathecal duramorph aka epidural - correct? I believe the femoral c-block is also the continuous femoral nerve block. If anyone has an explanation that would be appreciated. This is all getting billed to Medicare so if anyone has input as to what pays and what doesn't that is great.
 
The primary mode of anesthesia was the spinal. You will not get additional reimbursement for the Duramorph......it is included in the work of the spinal(and the post-op work will be included in your daily femoral nerve catheter management). It would appear that a continuous femoral nerve catheter was placed (with ultrasound guidance-need archived images with needle placement) for post-operative pain control 64448-59. There needs to be an order from the surgeon that turns the post-operative pain care over to the anesthesia department. You can get reimbursed for subsequent follow-up of the femoral catheter with the appropriate E/M code (whatever the documentation supports). As for the IV-PCA, as a rule Medicare and most payers do not pay.
Good Luck!
 
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