CMS Requires Surgeon to Document Reason for Post-op Pain Block

-->December 9, 2016Billing & Compliance Alerts

    By Bellinger Moody, RHIA, CPC-I, CPC, CCP

    Prominent Anesthesia Healthcare Compliance Attorney David Vaughn of Vaughn & Associates had several clients who “expressed the difficulty in obtaining a surgeon’s order stating why the surgeon is referring a post-operative pain block to anesthesia.  As a result, in an attempt to get CMS to change its mind, Attorney Vaughn wrote Dr. Niles Rosen, Medical Director of the NCCI (National Correct Coding Initiative*), trying to persuade him “that a surgeon’s order was only necessary if the surgeon transferred the entire course of the post-op care to anesthesia, and not merely the post-op pain block”.  Dr. Rosen stated that he disagreed with his view, but agreed to refer his question to CMS.

    CMS responded that the NCCI instructions quoted above applies to “postoperative pain management services,” and concluded that, “it is the responsibility of the surgeon to document in the medical record the reason that he has referred to an anesthesiologist for assistance with postoperative pain management.”

    Chapter 2 of the National Correct Coding Initiative states, “Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon.  The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner.” This recent direct response from CMS further clarifies and underscores CMS’s position that the surgeon must document why he is requesting a post-op pain block from anesthesia.

    Attorney Vaughn’s final analysis of this response was that “this is utter nonsense since it assumes the anesthesiologists are either incompetent and can’t make that determination themselves, or alternatively, that they will defraud the government by ordering blocks where they are not medically necessary, neither of which is true”.

    This response from CMS raises many questions – with the question of medical necessity being at the forefront – especially due to the fact that many surgeons are not even qualified to provide these services.  Will the Surgeon’s fee be reduced?  Will CMS recoup payments from anesthesia providers as a result of this recent statement?  Will CMS include this issue in the OIG Work Plan for 2018?  As you can see, there are a litany of questions that are raised here; however, we will be closely monitoring this issue in the months and years to come and will keep you abreast of developments in pain management billing and coding.

    Medac, Inc. handles all aspects of anesthesia and pain management billing and coding. Contact us today to find out how we can help your practice’s revenue cycle management.

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    The information presented herein reflects general information that is current as of the date it was first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author’s presentation of this information might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.