Pain Management – Anesthesia
Pain Management Consultation
Evaluation and management services for postoperative pain control on the day of surgery are considered part of the usual anesthetic services and are not separately reportable. When medically necessary and requested by the attending physician, hospital visits or consultative services are reportable by the anesthesiologist during the postoperative period. However, normal postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported.
Postoperative Pain Control Procedures
When provided principally for postoperative pain control, peripheral nerve injections and neuraxial (spinal, epidural) injections can be separately reported on the day of surgery using the appropriate CPT procedure with modifier -59 (Distinct Procedural Service) and 1 unit of service. Examples of such procedures include:
62310-62319 Epidural or subarchnoid injections
64415-64416 Brachial plexus injection, single or continuous
64445-64448 Sciatic or femoral injections, single or continuous
64449 Lumbar plexus injections, continuous
These services should not be reported on the day of surgery if they constitute the surgical anesthetic technique.
NOTE: Modifier 59 requires that the medical record substantiate that the procedure or service was a distinct or separate services performed on the same day.
Daily Management of Continuous Pain Control Techniques
Daily hospital management of continuous epidural or subarachnoid drug administration is reported using CPT code 01996 (1 unit of service daily). This code may be reported on the first and subsequent postoperative days as medically necessary.
When continuous block codes 64416, 64446, 64448, or 64449 are reported on the day of surgery, no additional reporting of daily management is permitted during the following ten days (10 day global period). When these injections procedures constitute the main surgical anesthetic and are therefore not separately reported on the day of surgery, subsequent days’ hospital management is reported using the appropriate hospital visit code (99231-99233).
62310, 62311, 62318 and 62319
Blue Cross and Blue Shield of Texas has determined that these procedures are surgical services and claims should reflect a type of service of 2. These codes will be reimbursed at the current maximum allowable as determined by HMO Blue Texas and Blue Cross and Blue Shield of Texas. Claims filed with CPT anesthesia procedure code 01991 or 01992 and type of service of 7 will be reimbursed on time and points methodology.
Epidurals administered for the prevention or control of acute pain, such as that which occurs during delivery or surgery, are covered by the Professional Services Program for this purpose only. Epidurals given to alleviate chronic, intractable pain are not covered.
If a recipient requests treatment for chronic intractable pain, the provider may submit a claim for the initial office visit. Subsequent services provided for the treatment or management of this chronic pain are not covered and are billable to the patient. Claims paid inappropriately are subject to recoupment.