Download SPECIALTY TIP #7 Post-Operative Pain Management

ICD-10 SPECIALTY TIPS
SPECIALTY TIP #7
Post-Operative Pain Management
Post-operative pain is a vital part of the successful recovery for a patient following surgery, and many surgeons value
the skillful management of pain by anesthesiologists.
The Basics:
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Per Correct Coding Initiative edits - Postoperative pain management services are generally provided by the
surgeon who is reimbursed under a global payment policy related to the procedure. They shall not be
reported by the anesthesia practitioner unless separate, medically necessary services are required that
cannot be rendered by the surgeon.
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Therefore, notation of the request by the surgeon MUST be noted in the record!
It is appropriate when the anesthesia for the surgical procedure was not dependent upon the
efficacy of the regional anesthetic technique.
Epidural injections or peripheral nerve block injections administered pre-operatively or
intraoperatively are not separately reportable for post-operative pain management if the mode of
anesthesia for the procedure is monitored anesthesia care, moderate conscious sedation, regional
anesthesia by peripheral nerve block, or other type of anesthesia (i.e., if the mode of anesthesia is
not general) per 2013 NCCI edits.
The AMA says it is appropriate to report pain management procedures for post-op analgesia separately from
the administration of a general anesthetic. "Whether the block procedure (insertion of catheter; injection of
narcotic or local anesthetic agent) occurs pre-operatively, post-operatively or during the procedure is
immaterial."
o Note the time of the procedure to determine if discontinuous time must be subtracted from the
anesthesia time.
Timing:
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When the block is placed before anesthesia time starts or after it has ended, the time spent placing the
block should not be included in reported anesthesia time.
Time spent on the placement of the post-operative pain block that occurs after induction and prior to
emergence is included in reported anesthesia time. In such cases, it is not necessary to report discontinuous
anesthesia time.
Epidurals for Post-operative Pain Management
Whether single injection or continuous, it is only billable if the mode of intraoperative anesthesia is general
anesthesia and the adequacy of the intraoperative anesthesia is not dependent on the epidural injection.
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Epidural or subarachnoid injections utilized for intraoperative anesthesia and post-operative pain
management are not separately reportable on the day the epidural or subarachnoid catheter were
inserted; rather, but may be reported for pain management beginning the day after insertion (CPT
code 01996) through discontinuance.
Daily Management Coding for other than Epidurals and Subarachnoid Continuous Infusion
In 2009, the following revised descriptors no longer included daily management. Postoperative daily visits will be
eligible for separate reporting with an appropriate E&M (evaluation and management) code.
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ICD-10 SPECIALTY TIPS
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64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement),
including daily management for anesthetic agent administration
64446 Injection, anesthetic agent; sciatic nerve plexus, continuous infusion by catheter (including catheter placement),
including daily management for anesthetic agent administration
64448 Injection, anesthetic agent; femoral nerve plexus, continuous infusion by (including catheter placement, including
daily management for anesthetic agent administration
64449 Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including
catheter placement), including daily management for anesthetic agent administration
https://www.asahq.org/quality-and-practice-management/practice-management/coding-and-billing-information/continuous-infusioncoding-change-2009#
Documentation Requirements:
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Administer the post-operative pain block per a surgeon's request. This must be specified in the medical
record.
Document the time spent administering the block separately from the anesthesia time.
o This would be advisable even if the pain block was administered after induction and prior to
emergence.
o Since Anesthesiology is subject to concurrency rules, be sure to document your time for subsequent
day pain management on the floors.
o Attach a modifier -59 when applicable (to differentiate from anesthesia so as not to be bundled into
the surgical anesthesia package).
Document the method for administering the block separately from the method for administering the surgical
anesthesia (usually via a separate section in an EHR or separate block record).
Indicate the purpose or the reason for the block, as well as the specific site of pain.
o “Interscalene block administered for post-op pain management for shoulder pain per surgeon’s
request”.
Indicate the type of block or catheter that was performed. Include in the description:
o How the patient was prepped
o Any topical anesthesia used
o Description of the procedure; include as applicable:
 Medications, dosage, needle size, location (laterality), imaging
o Any dressings used
o Outcome
If imaging is used, document retention of images as appropriate (“Images retained”).
o Be sure to check with your facility, not all EHRs will automatically retain the images so you may have
to print and include in the patient’s medical record.
o The images have to be “reproducible” in order to support coding.
Date and legible signature.
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ICD-10 SPECIALTY TIPS
There are many pain codes; below are a few that are used most often.
Condition
Post-op/ Post-Procedural Pain
Post-Thoracotomy Pain
Abdominal Pain
Joint Pain
Lower Extremity Pain
Upper Extremity Pain
ICD-10
G89.18
G89.12
Generalized? (R10.84)
Acute abdomen? (R10.0)
Ankle (M25.57-)
Elbow (M25.52-)
Finger (M79.64-)
Foot (M79.67-)
Hand (M79.64-)
Hip (M25.55-)
Knee (M25.56-)
Shoulder (M25.51-)
Toe (M79.67-)
Wrist (M25.53-)
Foot (M79.60-)
Lower leg (M79.67-)
Thigh (M79.65-)
Toe (M79.67-)
Axilla (M79.60-)
Finger (M79.64-)
Forearm (M79.64-)
Hand (M79.64-)
Upper arm (M79.62-)
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Additional Information
The secondary code would be the actual location of
the pain (i.e., rib pain, shoulder pain, etc.”
Specify quadrant
•Lower/RT or LT (R10.3-)
•Upper/RT or LT (R10.1-)
•Periumbilic (R10.33)
•Epigastric (R10.13)
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Laterality?
th
•Right is usually “1” for the 6 character
th
•Left is usually “2” for the 6 character
•”9” usually indicates unspecified (not advised)
Common post-op pain codes used
62310
62311
62318
62319
64415
64416
64420
64421
64445
64446
64447
64448
64450
64486
64487
64488
64489
64450
64447
64448
64447
64448
Epidural Injection – Cervical/Thoracic, single
Epidural Injection – Cervical/Thoracic, Continuous
Imaging may or may not be reimbursed per carrier
Epidural Injection – Lumbar/Sacral, single
Epidural Injection – Lumbar/Sacral, Continuous
Brachial plexus, (interscalene) single
Brachial plexus (interscalene), Continuous
Intercostal nerve, singe
Intercostal nerve, multiple, regional block
Sciatic nerve, single
Sciatic nerve, Continuous
Femoral nerve, single
Femoral nerve, Continuous
Other peripheral nerve or branch
Transversus abdominis plane (TAP) block, unilateral, injection, includes imaging
Transversus abdominis plane (TAP) block, unilateral, Continuous, includes imaging
Codes not recognized by all payors –
Transversus abdominis plane (TAP) block, bilateral, injection, includes imaging
64450 may have to be used instead
Transversus abdominis plane (TAP) block, bilateral, Continuous, includes imaging
Fascia Iliaca Block
Saphenous nerve block, single
Saphenous nerve block, Continuous
Codes per AMA / ASA response to direct questions
Adductor canal block, single
Adductor canal block, Continuous
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ICD-10 SPECIALTY TIPS
76942
77002
77003
-26
-26
-26
Ultrasonic guidance for needle placement, imaging supervision and interpretation (image must be retained)
Fluoroscopy for needle placement, off spine
Fluoroscopy for needle placement, spinal or paraspinous
The information provided is only intended to be a general summary and not intended to take place of either written law or
regulations.
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