Postoperative Pain Management Billing Conventions
Published on November 15, 2019
Although Medicare considers the management of postoperative pain to be the responsibility of the surgeon and includes it in the surgeon’s global fee, there are instances in which it is billable for anesthesia providers. If the postoperative pain management requires the skill of an anesthesia provider, and the surgeon requests it, it can be billed and reimbursed successfully observing a few billing conventions.
Postoperative pain management by anesthesia providers requires, first and foremost, a request or order from the surgeon. This request should be clearly documented in the patient’s medical record. Without a surgeon’s request, payers such as Medicare may audit the claim and determine it is not medically necessary. Other payers (commercial, WC etc) do allow for the anesthesiologist to document that the surgeon requested the block. Regardless of payer, the anesthesiology provider should document that the surgeon requested the block for postoperative pain management in his/her block note.
In addition to a surgeon’s order, the postoperative pain procedure must be clearly documented in the patient’s medical record. This includes a full description of the procedure, any radiological guidance that was used and a permanent image of the guidance. Many payers will not reimburse claims for ultrasound guidance without a copy of the image.
The postoperative pain block can be performed before, during or after the surgery. If it is done before induction or after emergence from anesthesia, the time to place the block should not be included in anesthesia time, but if it is done during surgery the time does not need to be deducted.
Another very important aspect of postoperative pain management billing is the purpose of the procedure. If the pain management procedure’s purpose is to manage postoperative pain, it is billable only if the primary method of anesthesia does not depend on the pain management procedure for efficacy. If the purpose of the procedure is to supplement/enhance the primary anesthesia, as in a combined anesthesia technique, it is not separately billable as postoperative pain.
Finally, appending a modifier to the postoperative pain code is necessary to alert the payer that the pain procedure is a separate and distinct service from the surgical anesthesia. These modifiers include the X- modifiers used by Medicare, XP (separate provider) or XU (overlapping service) most commonly and 59 which is accepted by many commercial payers.
Though guidelines for billing postoperative pain can be confusing, by observing a few best practices, anesthesia providers can easily be reimbursed for these valuable services while keeping their patients’ pain under control.
By Heather E. Golfos, CPC, CANPC
Coding Department Manager