Post-Operative Pain Management Coding: Drive in the Reimbursement
Article by Julia Rose
In case of surgeries, pain management coding gets tricky because it involves both pre and post-operative conditions where the patient requires medical care. Billing for an anesthesiologist’s post-operative 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. Your key to reimbursement is coding them separately, so that Medicare and private carriers recognize them as separate and distinct from services of other providers, such as the surgeon. In the postoperative period, hospital in-patients who have had major surgical procedures such as hysterectomy might be continuously infused with pain medication through an epidural catheter. The anesthesiologist can bill for placing a catheter intended for postsurgical pain management during surgery — if the line is not used for anesthesia administration during the operation. An important pain management coding guideline – subtract the time required to place the catheter from the surgery anesthesia time so the catheter insertion can be billed separately. Epidural drug administration for a hospital patient is eligible for Medicare reimbursement after the day the anesthesiologist inserted the catheter. If the surgeon inserts the catheter, the anesthesiologist’s time for daily management of drug administration can begin the same day. Follow-up care in this case is covered for a maximum of three days. Patient Controlled Analgesia or PCA is typically prescribed by the surgeon or the anesthesiologist, who can also determine the baseline and subsequent dosage, and is responsible for the medication’s infusion and subsequent management. However, these services are not separately payable by Medicare for either the surgeon or the anesthesiologist. Most payers won’t reimburse PCA because the patient performs the procedure. Make it a point to accurately represent the service provided. CPT coding convention for pain management coding states that it is not correct to use a code that is ‘close’ to the service provided. So, report an exact code.
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