Wiki "expected unacceptable post-op pain"

[Rita Bartholomew]

Our auditor has an issue with the "indication" listed on our forms used by anesthesia for post-op pain management procedure coding. The statement specifically is "Post-operative pain: requested by surgeon who ordered the block for expected unacceptable post-op pain."

The issue is with the word "expected" and whether this will be a problem with Medicare auditors (RAC). Does anyone feel this word precludes coding these as separate procedures.

 

[Michele Hannon]

The ICD9 Chapter 6 Coding Guidelines clearly state under #3 that "routine or expected postoperative pain immediately after surgery should not be coded."

You might consider changing your verbiage.

 

[Rita Bartholomew]

We do apply that rule when assigning diagnosis codes. Our uncertainty is about whether this "indication" supplies medical necessity for separate billing of anesthesia services for procedures performed postoperatively for unacceptable pain that was "expected" -- for instance, with certain types of procedures or for a patient with an opiate dependence. We appreciate your experience in this type of coding.