Billing and Reimbursement for PNB

[CaliCatheter]

Hey all!

Need some help in increasing our reimbursement with peripheral nerve blocks and regional.

How do you guys normally bill for these? Do you use Modifier 59? Are you getting reimbursed as a CPT code or as units?

Any help would be much appreciated.

Thanks!

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[2ndyear]

59, have to document surgeon request for post op pain management help. If you do the case as a block with MAC it’s time units only, no separate block reimbursement. Could technically bill time units for the block as start of anesthesia time though.

If it’s block and GA then CPT for the block and usual base plus time for the GA. Can’t do time units for the block in this case. Some insurers reimburse ultrasound some don’t.

 

[kmurp]

Hey all!

Need some help in increasing our reimbursement with peripheral nerve blocks and regional.

How do you guys normally bill for these? Do you use Modifier 59? Are you getting reimbursed as a CPT code or as units?

Any help would be much appreciated.

Thanks!

Two suggestions:
1. On your regional block form, place check boxes for whether the block was for postop analgesia or operative anesthesia. Also have a blank to fill in for pain location and requesting surgeon if it’s an analgesic block. Have a start and end time blank as well in case time is billed instead of cpt.
2. Have your group buy an ultrasound machine and bill for the global fee.

 

[somedumbDO]

Two suggestions:
1. On your regional block form, place check boxes for whether the block was for postop analgesia or operative anesthesia. Also have a blank to fill in for pain location and requesting surgeon if it’s an analgesic block. Have a start and end time blank as well in case time is billed instead of cpt.
2. Have your group buy an ultrasound machine and bill for the global fee.

Are you sure you can bill global for machine? I was told no by our billers

 

[kmurp]

Are you sure you can bill global for machine? I was told no by our billers

My understanding is that it’s controversial. That said, we have been doing it for 7-8 years for non Medicare payers and it’s more than paid for the ultrasound machine.

 

[CaliCatheter]

Thank you all for the reccs...

How can we bill for the time? My understanding is that its a CPT reimbursement. Is there a way around it?

Also, what does "bill global" mean?

 

[nimbus]

Thank you all for the reccs...

How can we bill for the time? My understanding is that its a CPT reimbursement. Is there a way around it?

Also, what does "bill global" mean?

What 2ndyear said earlier in the thread. There are 2 different situations.

If you do the block as the primary anesthetic and the patient does not also go to sleep, then you cannot bill the CPT for the block but you can bill for the time it took you to perform the block.

If the block is for postop pain management at the surgeon’s request, then you can bill the CPT code but not the time.

 

[jwk]

What 2ndyear said earlier in the thread. There are 2 different situations.

If you do the block as the primary anesthetic and the patient does not also go to sleep, then you cannot bill the CPT for the block but you can bill for the time it took you to perform the block.

If the block is for postop pain management at the surgeon’s request, then you can bill the CPT code but not the time.

The caveat you have to watch for here is medical direction. If the block is your primary anesthetic and you're billing for time, THAT is an anesthetic. You either have to bill the case as personally performed, or have an anesthetist signed in on the case as well.

 

[Simba1711]

My group is saying insurance will not reimburse for blocks unless a different anesthesiologist performs the block from the anesthesiologist giving the anesthesia in the or. Is this the case ? I don’t think this was true in my other practice and my other colleagues

 

[JoelJoel84]

My group is saying insurance will not reimburse for blocks unless a different anesthesiologist performs the block from the anesthesiologist giving the anesthesia in the or. Is this the case ? I don’t think this was true in my other practice and my other colleagues

Absolutely not true.

We do our own blocks in preop and then perform our anesthetic , and haven’t had any issues with any insurance company in a decade.

 

[Xcellerator]

You should be getting reimbursement. However at our shop, we don't get any units for block/lines or even modifiers such as extremes of age (<1yr, >70yr), etc. So no motivation for doing blocks here. We're base + production based with a small stipend for calls here. Definitely missing out on some units for us which is aggravating.

 

[nimbus]

You should be getting reimbursement. However at our shop, we don't get any units for block/lines or even modifiers such as extremes of age (<1yr, >70yr), etc. So no motivation for doing blocks here. We're base + production based with a small stipend for calls here. Definitely missing out on some units for us which is aggravating.

I bet the money from the blocks and lines is being collected and raising the pooled unit value. In that case, the people who do a lot of blocks and lines are subsidizing the people who do fewer blocks and lines.

 

[abolt18]

You should be getting reimbursement. However at our shop, we don't get any units for block/lines or even modifiers such as extremes of age (70yr), etc. So no motivation for doing blocks here. We're base + production based with a small stipend for calls here. Definitely missing out on some units for us which is aggravating.

I don't get anything extra for doing blocks (hospital employed). Kind of nice because I do blocks when I feel it's appropriate and skip it when I feel it's unnecessary.

 

[kidthor]

My group is saying insurance will not reimburse for blocks unless a different anesthesiologist performs the block from the anesthesiologist giving the anesthesia in the or. Is this the case ? I don’t think this was true in my other practice and my other colleagues

That is what my group's billers say as well, and I too had a prior group that seemed to have no problem billing/collecting for regional performed by the same primary attending. I'd love a definitive answer on this but I can't find any primary sources one way or the other.

I get the feeling a lot of anesthesia billing ends up being highly flawed and gets interpreted by non-physician administrators who have no idea what they're doing (all while 2-3% or whatever off the top despite F-ing everything up).

 

[Simba1711]

I will bring it up with group again. Since I’m in private practice units from lines and asa modifiers goes to our pool and shared among our members equally.

 

[Hoya11]

I don't get anything extra for doing blocks (hospital employed). Kind of nice because I do blocks when I feel it's appropriate and skip it when I feel it's unnecessary.

lol i would hope thats the case regardless of reimbursement!

 

[abolt18]

lol i would hope thats the case regardless of reimbursement!

Yeah but if you get paid more for the block, you are obviously incentivized to do more blocks, including ones of questionable utility or efficacy (not that I'm accusing anyone of doing this).

I was just saying that I kind of appreciate that I am able to take care of the patient how I see fit without feeling financial incentive to do more when the benefit to the patient could be marginal.

 

[Simba1711]

Yeah but if you get paid more for the block, you are obviously incentivized to do more blocks, including ones of questionable utility or efficacy (not that I'm accusing anyone of doing this).

I was just saying that I kind of appreciate that I am able to take care of the patient how I see fit without feeling financial incentive to do more when the benefit to the patient could be marginal.

This happened at my previous job. Lot of nerve blocks for diabetic patients with neuropathy. Example superficial peroneal nerve blocks for dresssing changes.

 

[GassYous]

This happened at my previous job. Lot of nerve blocks for diabetic patients with neuropathy. Example superficial peroneal nerve blocks for dresssing changes.

It seems silly until you get a bunch of phone calls for patients complaining of excruciating pain, especially the chronic pain and the chronic opioid users.