Monday, May 23, 2016

Pain Management Services IN ASC setup billing guide

The following information is intended for pain management rendered in a hospital or in an ambulatory surgical center.

The anesthesiologist may provide pain management services for acute (post-operative) or chronic pain. Pain management services typically consist of the administration of an anesthetic or analgesic agent by regional injection, causing partial or complete loss of sensation without loss of consciousness.

Injections or blocks administered as a therapeutic agent in the treatment of a non-surgical condition should be reported under the appropriate injection or block procedure codes. Nerve blocks and epidural steroid injections are reimbursed at a non-time based rate.

Procedure code 62318 and 62319 should be reported for the insertion of a catheter for continuous epidural or subarachnoid drug administration. Reimbursement will only be made for covered services related to chronic, intractable pain because of injury, illness, or post-operative pain management and any such payment will be presumed to include the following services:

• Initial placement of the catheter or cannula

• Monitoring of vital signs

• Subsequent injections

• Removal of catheter or cannula

The initial continuous epidural catheter placement procedure (62318, 62319) is reimbursed one time only at the beginning of the treatment program at a non-time based rate.

Daily hospital management of epidural or subarachnoid continuous drug administration (01996) may be a covered service under appropriate circumstances. Reimbursement for daily hospital management performed on the same day as the initial continuous epidural (62318, 62319) is included in the basic allowance for the initial continuous epidural. Daily hospital management (01996) is limited to one time daily on subsequent days. Time units are not recognized for CPT code 01996. It will be paid the base unit of three times the conversion factor. If a physician is billing for more than one day on a claim, each day should be listed on a separate line to allow appropriate reimbursement.

Evaluation and management services relating to pain management services are covered according to Florida Blue Medical Coverage Guidelines.

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