Reporting Perioperative Peripheral Nerve Blocks

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The following article is written by Rosalind Richmond, CCS, coding compliance officer for GENASCIS.

Pain relief procedures not specified to deliver primary anesthetic for a surgical procedure are separately reportable

Providers may bill for a regional anesthetic technique as a service separate from the anesthetic if the regional anesthetic technique is performed primarily for postoperative analgesia. Reporting pain management blocks require clear documentation distinguishing between anesthetic and analgesia.

Medical necessity for postoperative pain management must be documented by the requesting physician. Normal postoperative pain management including management of intravenous patient controlled analgesia is considered part of the surgical global package.

Reporting perioperative nerve blocks is appropriate when the following conditions apply:

• The anesthesia for the surgical procedure is not dependent on the efficacy of the regional anesthetic technique.
• Time spent on perioperative placement of the block must be separated and not included in the reported anesthesia time.

Key elements for documenting regional peripheral block procedures are as follows:

• Name of block performed
• Approach used
• Patient condition
• Indications for block
• Patient position
• Needle design, technique, depth of insertion
• Local anesthetic used
• Dose,
• Monitoring/narrative of event/description of motor response
• Patient vital signs following procedure

Documentation requirements:

• Requirement to document that regional block is separate from the operative anesthetic — In order to bill for any type of block separate from the anesthetic, the reason for performing the block must be for the provision of postoperative pain management.If a different provider provides the regional block than the provider who provides the surgery (anesthesiologist), a documented request must be noted by the surgeon indicating that the intent of the block is for postoperative pain control. This may be documented as a physician order.

• Requirement to document that the regional block is separate from routine postoperative surgical care —An order from the surgeon is required in addition to documentation requesting the regional block that daily analgesia management is planned. This activity must be defined as separate from routine postoperative pain management.

CPT 64400-64520

It is appropriate to report the codes below in conjunction with an operative anesthesia service when a peripheral nerve block injection for post operative pain management is performed.

These injections are administered pre, inter, or post- operatively.

Modifiers
The modifiers below are approved modifiers for use with peripheral block procedures. Payment will only be made once during an episode of care. Modifier -59 is required to distinguish the block from the intraoperative anesthetic technique. This is especially important when the same provider performs the nerve block and the intraoperative anesthesia.

Deficient documentation for pain block procedures occurs when:

• The postoperative pain block is dictated within the operative report and no separate procedure note for the block is provided.
• A postoperative pain procedure report that does not include "postoperative pain management" under indications is incomplete.
• Statements like "patient was given a femoral block followed by endotracheal anesthesia" are not complete without a physician order (verbal or written) requesting the block for pain management.
• "Anesthesia type — regional and general": Documentation must be inclusive of a block procedure report, with clear documentation relating to post operative pain control.

Diagnostic coding

Coding and sequencing for pain are dependent on the physician documentation in the medical record and application of the official coding guidelines for inpatient care.

Postoperative pain can be coded as a secondary diagnosis when the patient develops an "unusual or inordinate amount of postoperative pain" after outpatient surgery. Do not assign a code for the postoperative pain if it is routine or expected after surgery.

Learn more about GENASCIS.

References

CPT Assistant, Volume 7, Issue 2, February 1997

CPT Assistant, Volume 8, Issue 7, July 1998

ICD-9-CM Official Coding Guidelines

NHIC Anesthesia Billing Guide — www.medicarehic.com/providers/pubs/Anesthesia%20Billing%20Guide.pdf

CCI Policy Manual — www.cms.hhs.gov/nationalcorrectcodinited/01_overview.asp

The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

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