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POD 1 pain management

Melissa Posted Mon 28th of October, 2013 11:57:03 AM

I work for an Anesthesiologist group. We are receiving denials from Humana for post operative pain management the day after surgery. We are coding this as "99231". The patient is on continues venous pain medication and our Anesthestiologist is reading the patient chart, discussing pain levels with the patient, evaluating their pain,evaulating the catheter function, and making any adjustments necessary. The denials from Humana state "According to the AMA E & M services 99231 is not payable when billed the day before/the same day/the day after of an anesthesia service. I do not see that in the guidelines and they can not provide us with any place this is stated.

Is this a billable charge? If so, how do I bill this for reimbursement? If not, where do I find the information to back this up?

SuperCoder Answered Mon 28th of October, 2013 14:43:28 PM

The appropriate CPT codes to use for post-operative pain management performed by Anesthesiologists are CPT code '62310' and '62311' or '62318' and '62319'. Reporting epidurals or peripheral nerve blocks in conjunction with anesthesia must be accompanied by a modifier -59, which indicates that the epidural or block was administered for post-operative pain management. CPT codes '64400-64530' can also be billed.
Anesthesia providers must remember that post-operative pain management is separately reportable when the mode of anesthesia is general and not when the mode is MAC, moderate conscious sedation or regional.

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