The Opioid Crisis and Acute Postoperative Pain Management

By Pamela Linton, CPC, CANPC, Corporate Coding Manager – Anesthesia

We have all read or heard something in reference to the opioid crises in the news in recent weeks. While most of this stems from long term opioid use practitioners find themselves evaluating all aspects of opioid use, including the use in acute postoperative pain. The question becomes how to provide the best pain relief with the least amount of opioids. As more and more facilities and surgeons are looking for alternatives to opioids, anesthesiologists are beginning to see an increase in postoperative pain block requests. Several studies have shown that peripheral nerve blocks improve pain control and reduces opioid requirements when compared to opioids alone.

So what does this mean for the anesthesiologist? Traditionally surgeons are paid under a global fee – all of the services associated with a particular procedure are bundled into the fee for the surgery itself. This includes a preoperative evaluation, the intra-operative procedure, and postoperative care. Many surgical procedures have a global period of 90 days in which all patient encounters related to the procedure are bundled into the payment for the surgery and are not separately billable until after 90 days. Why is this important? Postoperative pain management services are generally provided by the surgeon who, as mentioned above, is reimbursed under a global payment policy related to the procedure. The anesthesiologist performing the pain block is asking a payer to reimburse them for a service that will technically be paid to the surgeon in their global fee.

How then does the anesthesia practitioner expect to be reimbursed for his/her services for acute postoperative pain management? The answer comes in a request from the surgeon to provide this service. The NCCI (National Correct Coding Initiative) Policy Manual, Chapter 2 states that this request must come from the surgeon and that it is the surgeon’s responsibility to document this request in the medical record. In the absence of a documented request from the surgeon, the next best thing is for you to document this request in your procedure note.

Acute Pain Block Documentation Reminders:

  • The block cannot be the mode of anesthesia for the surgical procedure
  • A documented request from the surgeon
  • A detailed procedure note – should include a time range for the block which shows a payer that the time spent placing the block was not included in the billable anesthesia time
  • If ultrasound guidance is used, a picture must be saved that can be retrieved in the event of a payer audit

Ultrasound Guidance is separately billable for most peripheral nerve blocks. It is, however, bundled into the following blocks:

  • TAP Blocks (New Codes Created 01/01/2015)
  • Paravertebral Blocks (New Codes Created 01/01/2016)

The requests for anesthesiologists to provide acute postoperative pain relief are on the rise. As is required in all billing scenarios, good documentation is the key to success.