Successful Claims and Appeals for Postoperative Pain Nerve Blocks - Appeals Newsletter Part 10

Make sure your staff know how to bill postoperative Nerve Blocks and the necessary documentation to get your claims or appeals right the first time. Review the following guidelines from the National Correct Coding Initiative (NCCI) Manual:

  1. Postoperative pain management services are provided by the surgeon under a global payment policy for the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required of the anesthesiologist.

    The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner.

  2. An epidural or peripheral nerve block injection administered preoperatively or intraoperatively is not separately reportable for postoperative pain management.
  3. If an epidural or peripheral nerve block injection for postoperative pain management is reported separately on the same date of service as an anesthesia 0XXXX code, modifier 59 or XU may be appended to the epidural or peripheral nerve block injection code to indicate that it was administered for postoperative pain management.
  4. An epidural or peripheral nerve block injection for postoperative pain management in patients receiving general anesthesia, spinal anesthesia, or postoperative pain management by epidural injection as described above may be administered preoperative or intraoperatively will be paid as part of the global surgery package, not separately.

Tip: To avoid denials, code to the highest level of specificity.  Do not use an unlisted code unless there is no other more specific code to use. If using an unlisted code please be sure to submit documentation through the PWK segment to provide information regarding the procedure.

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