The new healthcare reality in light of reform places greater emphasis on provider efficiency, clinical outcomes and patient satisfaction. As providers transition to the ICD-10 coding system, adopt new technologies and tighten revenue cycle management to overcome lower reimbursements, new best practices start to emerge.
With regard to post-operative pain management procedures, there is a growing need for heightened documentation from clinicians. The ICD-10 coding system is more sophisticated and complex than its ICD-9 predecessor, as the library of codes has increased exponentially. To ensure coding and billing teams select the most appropriate codes for each procedure to guarantee reimbursements, clinicians must clearly document all aspects of treatment.
Improved notation of the patient experience will also help healthcare providers enhance clinical outcomes and increase patient satisfaction scores. When post-operative pain management procedures are not documented properly, revenue may suffer, the patient may develop chronic pain and clinical outcomes will plummet. Practioners must keep a watchful eye on documentation guidelines and changes to avoid damaging errors or oversights.
Adjusting To Payor Demands
As healthcare providers adjust practices to meet the requirements for the ICD-10 rollout, anesthesia providers should ensure their documentation reflects specific aspects of post-operative pain management procedures to ensure proper reimbursement rates and improved clinical outcomes.
Notation should describe how a pain block was utilized in response to a surgeon’s request, documenting time for administering a block after induction as separate from anesthesia time, and using a modifier 59 when appropriate. The method for implementing a post-operative pain block should be documented separate from that of surgical anesthesia, as well as the purpose for the block, type of block or catheter performed and sites of pain the patient is experiencing.
Unfortunately, payor requirements for post-operative pain management procedure reporting and coding vary. It is imperative for anesthesia providers to pay close attention to different provider specifications to prevent errors or claims denials. Post-operative pain blocks are especially vulnerable to discrepancies between payor coding preferences, underscoring the importance of detailed documentation to keep the appropriate procedures separate from general anesthesia and sustain strong revenue streams.
Some commercial payors allow an operative report or procedure note for post-operative pain management injections independent of other documentation. Other payors have their own medical necessity and provider demands that must be met, such as appropriate use of a modifier 59 when independent procedures are performed on the same day by the same physician. When a modifier 59 is added to a CPT code it is not considered a bundled component of a more comprehensive code or multiple codes that should not be reported together, and is eligible for payment when in compliance with the CPT coding book rules.
Documenting Like A Pro
As post-operative pain management procedures are key to reducing the length of stay for a patient, as well as the potential for costly complications, it is important these steps be notated accurately. In this year’s National Correct Coding Initiative edits from the Centers for Medicare and Medicaid, some changes were made specifically to the documenting and coding for post-operative pain management procedures. Healthcare providers must stay abreast of the latest changes to ensure they are demonstrating best practices and contributing to an efficient, sustainable delivery of care.
Any changes to post-operative pain management documentation under the edits apply to reporting procedures separate from anesthesia when it is general. For example, epidurals and blocks placed pre-operatively to manage post-operative pain are typically reported separately from the bundled anesthesia services. According to the NCCI’s 2013 edits, however, if the epidural or the block is the anesthesia in the procedure, the rule does not apply.
Furthermore, epidural injections and peripheral nerve block injections for post-operative pain management are to be reported separately from anesthesia if the intraoperative anesthesia is general and not dependent on the injections. When anesthesia is not general, epidural injections and peripheral nerve block injections are reported in a bundle with anesthesia procedures.
In addition, a subarachnoid catheter or epidural can be reported as pain management the day after insertion through discontinuance, while adding the modifier 59 to epidural and nerve block documentation in conjunction with anesthesia indicates they were used for post-operative pain management.
The American Society of Anesthesiologists guidelines for post-operative pain management documentation in conjunction with anesthesia enable a provider to bill for a regional anesthetic technique separate from the anesthetic if it is implemented post-operative and:
- Anesthesia for surgery was not dependent on the efficacy of the regional technique
- Time spent on pre- or post-operative block placement is not included in anesthetic reporting time
- Time spent on a post-operative pain block after induction but before emergence can be included in the reported anesthesia time
When documenting all post-operative pain management procedures, clinicians must keep in mind the importance of separating services from anesthetic services to ensure optimal reimbursement potential and accuracy in coding.
When clinicians work with knowledgeable medical coding and billing providers with experience in anesthesia and pain management services, compliance risks are minimized and reimbursements for post-operative procedures are optimized, thus creating a foundation for long-term sustainability.
