Get Reimbursed for Anesthesiologist

Postoperative Pain Management

By Susan Dooley

When a surgeon asks your anesthesiologist to perform a nerve block postoperatively for pain control,
some tricky coding issues could keep you from obtaining full reimbursement for this otherwise separate
service.

When Can Anesthesiologists Bill Separately for Postop Pain

Management?
According to the American Society of Anesthesiologists (ASA), you can bill for a separate postoperative
pain procedure, but you need to keep these conditions in mind:

1. Dont perform the surgery under regional anesthetic alone.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

For example, say an anesthesiologist places a femoral nerve block before knee surgery to allow for
prolonged postop pain control. To be able to bill separately for this, the surgery itself must be
performed under general, spinal, or epidural anesthetic. Doing the surgery under monitored anesthesia
care (MAC), the regional block alone, or IV sedation would make separate billing for postop pain control
impossible. Thats because the femoral block in those cases was the primary anesthesia.

2. Separate out any time spent on postsurgical pain blocks from

the reported anesthetic time.
Theres nothing wrong with placing a postsurgical pain block before anesthesia is induced or after the
patient wakes up from anesthesia. But if your anesthesiologist does this, make sure she doesnt add the
time spent placing this block to the reported anesthesia time.

3. Dont separate time for postsurgical blocks done while patient is

under anesthesia.
In other words, if the postsurgical pain block is placed while the patient is under anesthesia that is,
after induction and prior to waking up from anesthesia dont deduct the time spent performing the
block from the total anesthesia time.

Document the Service to Clarify

The ASA suggests dictating the details of the postsurgical pain block so that they appear in the chart in a
location that is separate from the anesthesia record and from the surgeons record of the operation,
such as in a consultation or a progress note. Make sure the documentation discusses the surgeons
request for the anesthesia team to provide postoperative analgesia. The note should also detail
preoperative talks with the patient in which the anesthesiologist and patient determined a plan for
postop pain control. You should also document that you discussed risks and benefits of the postsurgical
pain block therapy separately from discussion of the surgical anesthesia itself, and that the patient
consented to this procedure.
Payers may also want the surgeon to document the request for the pain block, in addition to
documentation from the anesthesiologist. Additionally, some coders recommend submitting a separate
claim form for the anesthesia during surgery and for the postoperative block, even when the same
physician performed both services. No payer requires this, but the coders suggest that submitting two
claim forms could help the payer understand the situation more clearly.
Final tip: If youre a surgical coder instead of an anesthesiology/pain management coder, remember that
there are National Correct Coding Initiative edits (aka NCCI edits or CCI edits), based on statements in
chapter 12 of CMSs Medicare Claim Processing Manual, describing the surgeons postop pain
management as part of the global surgical package.

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com

How About You?

Im curious whether anesthesia coders run into this postsurgical pain block situation frequently. If you
work in anesthesia coding, has this procedure been a common one for you? Let us know!

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Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
shyamn@codinginstitute.com