How changing modalities create coding & billing challenges in anesthesia — 7 takeaways

Emerging approaches to using nerve blocks for acute pain improve surgical outcomes, but they also create coding and billing challenges for anesthesia practices, according to Anesthesia Business Consultants President and CEO Tony Mira.

Here are seven takeaways:

1. As blocks continue emerging, it's crucial to have a billing and coding team with a deep understanding of acute pain management and Current Procedural Terminology codebook changes.

2. For anesthesia, most charges are calculated based on surgical complexity and anesthesia time. Payment for nerve blocks, on the other hand, is determined by the CPT Fee Schedule.

3. Three primary details are needed to bill a nerve block for postoperative pain management:

  • Whether the block was performed before or after induction
  • Confirmation the block was performed for postoperative pain management
  • Confirmation the block was performed at the request of the surgeon

4. The CPT code list doesn't include many relatively new nerve block approaches, so payers often have to manually examine the coding and billing for unlisted acute pain management services.

5. These unlisted services are often billed using CPT code 64999, but carriers rarely reimburse them.

6. The CPT code list typically includes specific codes for unilateral and bilateral single injection, as well as continuous catheter insertion, for most accepted nerve block modalities. However, some nerve blocks don't have codes for each of those delivery options.

7. Some anesthesiologists recently began performing a block in the interspace between the popliteal artery and capsule of the posterior knee to reduce pain after knee surgery and reduce the postoperative need for opioids. This and other emerging blocks will change the coding and billing landscape for acute pain management.

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