Pain Management Consultation
Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal
postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.
postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.
Postoperative Pain Control Procedures
When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service.
Examples of such procedures include:
62310-62319 Epidural or subarchnoid injections
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous
These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.
NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.
Daily Management of Continuous Pain Control Techniques
Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.
When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).
Billing for an anesthesiologist’s postoperative services – such as epidural analgesia, nerve blocks and patient-controlled administration of analgesia – frequently challenges coders and billers, because these procedures are sometimes bundled with the surgical payment... The key to reimbursement is coding these services so Medicare and private carriers recognize them as separate and distinct from services of other providers, such as the surgeon...
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