Post-Operative Pain Management and Epidural Catheters
Surgeons routinely provide necessary post-operative pain management
services and are reimbursed for these services through the global surgery
fee. The surgeon should manage post-operative pain except under
extraordinary circumstances. Procedures involving major intra-abdominal,
vascular and orthopedic, and intrathoracic procedures will be covered for
post-operative pain management by an anesthesiologist when medically
indicated. Postoperative pain management services is not covered by nonphysicians.
The definition for post-operative pain management is the management of a
recipient’s pain beyond, or separate from, the recovery room or operating
room. The separately identifiable physician-recipient encounter and
management should occur outside the intraoperative area. A separately
identifiable physician-recipient encounter reflecting the prescription of
medication, associated monitoring, adjustment(s) of medication, and ongoing
assessments for complications should be clearly reflected in the medical
record documentation.
No additional payment is allowed for an injection of Duramorph or other
analgesic agents as a boost at the end of an anesthesia procedure (using the
same catheter used for the epidural or spinal anesthesia) without a separately
identifiable physician-recipient encounter including the prescription of
medication, associated monitoring, adjustment(s) of medication, and ongoing
assessments for complications. However, if there is a separately identifiable
physician-recipient encounter on subsequent post-op days, where the
physician provides post-operative analgesic orders and manages postoperative
analgesic complications, daily management of epidural or
subarachnoid drug administration may be billed.
If a recipient receives general anesthesia and consequently requires
additional pain control such as an epidural injection or an epidural catheter
placement on the same day as the general anesthesia, the single injection or
catheter placement will be reimbursed at one-half of the allowable. However,
catheter placement and daily management of an epidural catheter is not allowed on the same date of service. When the physician provides a separately identifiable physician-recipient encounter to manage and evaluate the catheter and it is reflected in the medical record, this coverage is
satisfactory for a reasonable period of time over the consecutive postoperative
days.
