CMS not Paying for blocks

[hellothane]

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Members don't see this ad.

http://www.beckersorthopedicandspin...hallenges-q-a-a-with-peggy-hapner-of-medlearn

Not good.

 

[SleepIsGood]

http://www.beckersorthopedicandspin...hallenges-q-a-a-with-peggy-hapner-of-medlearn

Not good.

I think this is pertinent to surgeons adn the joint injections or iNTRAOP injections they do. NOT for blocks that we do: fem, sciatic, axillary,etc.

right?

 

[hellothane]

I regret to say no, there are reports of nonpayment already.

 

[Coastie]

I regret to say no, there are reports of nonpayment already.

non payments for regional blocks?

Are you insane?

 

[thegasman]

this appears to address additional payment for regional blocks performed for postop pain in addition to other anesthetic technique (ga). If this occurs, I know my group will be very reluctant to perform blocks at all. Why take a risk of a complication (even if very small) when there is no financial incentive to perform the service?

 

[Monty Python]

this appears to address additional payment for regional blocks performed for postop pain in addition to other anesthetic technique (ga). If this occurs, I know my group will be very reluctant to perform blocks at all. Why take a risk of a complication (even if very small) when there is no financial incentive to perform the service?

Noridians' new policy. aka: J3
> CA2006.15 R6 effective 01/15/2010
>
> From page 19 of 23:
>
> OTHER SPECIFIED AFTERCARE FOLLOWING SURGERY
>
> *Reimbursement for the control or management of pain in the immediate
> postoperative period is bundled into the payment for the procedure,
> surgical or anesthetic-regardless of the method by which the care
> provider, including the anesthesiologist, decides to manage the pain.
> Following discharge from the post-anesthesia care unit (PACU), the
> medically reasonably and necessary placement of regional or peripheral
> pain blocks or initiation of other new pain interventions or "top up"
> dosing may be reimbursable. Providers should not expect separate payment
> for the establishment of epidural or other pain blocks unless the block is
> placed following discharge from PACU due to documented inadequate pain
> control.


The way I'm reading it:

1. no separate payment for preop placement of the femoral/shoulder/epidural block or catheter
2. the patient must be writhing in pain, after discharge from PACU, for the pain procedure to be performed and reimbursed separately.

Meaning .... does the patient come back to the block room for pre-block sedation, or will we be expected to visit them on the ward and do the block there sans sedation? (not an approved sedation place).

Obviously Noridian had some Doctor of Nursing Practice write this new policy.

 

[MDEntropy]

This is interesting and I am not 100% sure how to interpret it.

I believe these specific NCCI edits are aimed at orthopedists and is an attempt to keep them from billing for multiple things at once. Take for example an orthopedist who does an ORIF of something and bills for it, but also bills separately for making an incision, shooting x-rays, debriding and doing a nerve block. I think the goal of these edits is to stop this additional billing and only allow the orthopedist to bill for the ORIF.

My guess is that, at this time, it is still appropriate for a separate practitioner to bill for these other services such as a block.

Payment should not be denied BY MEDICARE for your nerve block because someone else did a procedure which could include a nerve block. Other payors, may try to misinterpret this and not pay ANYONE.

It is still probably best to bill for these services such as blocks separately with a 59 modifier and billing for anesthesia time simultaneously, although done commonly, could be considered fraud.

 

[BDanes]

Whenever I do blocks I specifically write out a procedure note in the progress notes and state it is for postop pain relief. I save a copy to send/retain for billing. I also do not charge for anesthesia time until after the block is done.

If they stop reimbursing then fu ck them. They already have shi tty reimbursement, and I won't do them anymore. Welcome to govt rationing of care. Sorry patients- take it up with your senator

 

[urge]

This will kill regional anesthesia. The only reason regional picked up in the last few yrs was because you could "double bill",ie do a block, place a tube and bill for both. Honestly that practice never seemed right to me. Why? Because 99% of the time that pt didn't need a tube, or 99% of the time they needed the tube because your block was so crappy that it wasn't worth billing for it.

I want to see how much interest people will have in regional from now on.

 

[2win]

This will kill regional anesthesia. The only reason regional picked up in the last few yrs was because you could "double bill",ie do a block, place a tube and bill for both. Honestly that practice never seemed right to me. Why? Because 99% of the time that pt didn't need a tube, or 99% of the time they needed the tube because your block was so crappy that it wasn't worth billing for it.

I want to see how much interest people will have in regional from now on.

So you can say when an internal medicine doc is placing a patient on certain BP medication and doesn't work he shouldn't bill???
I totally disagree with the new reimbursement policy ( I didn't check yet with my billing company) - this is an intolerable interference in the practice of anesthesia.
Let's not pay anymore for an attempt for pancreatic resection because it was discovered during the procedure that the pancreas is not resectable...

 

[BLADEMDA]

Just do the right thing but KISS. This means quick bread and butter blocks that work and don't take long to perform.

At my place we have been getting stiffed for years on reimbursement for these procedures. They reimburse poorly and probably will go to zero; but, the numbers (collection for blocks) are so low for my Group that it doesn't matter. We do them for surgeon and patient satisfaction. Get used to it boys and girls as that is the future.

So, KISS keeps the practice moving and delivers enough surgeon/patient satisfaction to keep the cases from going elsewhere.

 

[2win]

Just do the right thing but KISS. This means quick bread and butter blocks that work and don't take long to perform.

At my place we have been getting stiffed for years on reimbursement for these procedures. They reimburse poorly and probably will go to zero; but, the numbers (collection for blocks) are so low for my Group that it doesn't matter. We do them for surgeon and patient satisfaction. Get used to it boys and girls as that is the future.

So, KISS keeps the practice moving and delivers enough surgeon/patient satisfaction to keep the cases from going elsewhere.

I do agree....
"keep the cases from going elsewhere" - like where? Mexico?
VA style boys and girls. Keep the laptop on the anesthesia card and have fun.

 

[Coastie]

Just do the right thing but KISS. This means quick bread and butter blocks that work and don't take long to perform.

At my place we have been getting stiffed for years on reimbursement for these procedures. They reimburse poorly and probably will go to zero; but, the numbers (collection for blocks) are so low for my Group that it doesn't matter. We do them for surgeon and patient satisfaction. Get used to it boys and girls as that is the future.

So, KISS keeps the practice moving and delivers enough surgeon/patient satisfaction to keep the cases from going elsewhere.

You guys don't get reimbursed for blocks?

I thought blocks were anywhere from 6-10 units.

Why don't they pay you guys for them? What's the deal? Why do a regional fellowship?

 

[ProRealDoc]

Nurse hallothane is wrong on this issue.

http://www.anesthesiallc.com/ealert...-medicare-denials-based-on-cci-bundling-edits

You may have started receiving unexpected denials from Medicare for epidural injections and nerve blocks performed together with a number of invasive monitoring line insertions and injection/aspiration procedures. THESE DENIALS MAY BE WRONG, according to a response received by the American Society of Anesthesiologists (ASA) questioning the change that "bundled" the procedures.



Unfortunately, the Medicare carriers will continue to reject claims for bundled pain codes until they receive the next version of the data files from the Centers for Medicare and Medicaid Services (CMS) for implementation on October 1, 2009. You have two options for receiving the proper payment amount, both of which are disruptive but inevitable at this point:

1. Hold your affected claims and submit them to your carriers after October 1, 2009, or
2. Keep track of all the bundling denials for services provided between April 1, 2009 and October 1, and resubmit the affected claims or appeal the denials after October 1.

How did this happen? Many if not all of you will recognize the name "National Correct Coding Initiative" ("NCCI," "CCI"). Since 1996, the Medicare carriers have run physician claims for multiple procedures performed on the same patient, on the same date of service, against the CCI lists of prohibited code pairs. The NCCI's principal tool is the Column One/Column Two Correct Coding Edits table. Column One lists "comprehensive" codes or other codes frequently billed together with an inappropriate code in Column Two; "Column Two" codes are those that are considered a component of the associated Column One codes and should not normally be reported separately or "unbundled." If a claim contains a pair of codes for which there is a CCI edit, the Column Two code is denied unless it is submitted with a CCI associated modifier, e.g. -59 (distinct procedural service) and the edit in question allows such modifiers. Some CCI edits do not allow payment for the Column Two code under any circumstances, but many do. Those that never allow the Column Two code to be unbundled are identified with the indicator "0" while those that allow the edit to be bypassed and both procedures to be paid use the indicator "1." For more information on the CCI and its system of edits, consult the Overview and links of interest on the CMS website.
CMS updates the CCI every quarter, based on new codes or new analyses of coding practices, following consultation with various internal and external advsisors, as well as with the medical specialty societies. The proposals for CCI changes that were implemented on April 1st had been reviewed by more than 100 national healthcare organizations, according to the NCCI contractor's letter to ASA. Retroactive reversals such as the one just made are nevertheless not uncommon because thousands of codes are reviewed in and as groups.
At the carrier level, however, eliminating edits that have been reversed or withdrawn must await the release and installation of the next version of the NCCI data tapes – in this instance, NCCI version 15.3 by October 1st.
In version 15.3, nerve blocks and epidural injections will continue to be separately payable, as long as they are submitted with the appropriate modifier (typically modifier -59) that will deactivate the CCI edit. Use of the modifier will signal the carrier to allow the claim for the epidural or nerve block submitted with the Column One codes in the table below. Version 15.2, currently on the carriers' computers, does not recognize the modifiers or allow the edit to be bypassed.



Version 15.3 COLUMN ONECOLUMN TWOINDICATOR

• Injection procedures
  • 20550-20553 (includes trigger points)
  • 20600-20612
  • 27096 (sacroiliac joint injection)

• Nerve blocks
  • 64400-64530
• Epidural injections
  • 62310-52319

1

• Lumbar spinal puncture for diagnostic purpose
  • 62270

• Epidural injection
  • 62310

1Retaining these edits, but listing them with indicator 1, means that if an anesthesiologist performs a Column Two procedure for pain management (not for anesthesia) together with a Column One procedure, the epidural or nerve block may be reported with a modifier (-59).





Also in version 15.3 of the NCCI, CMS has deleted edits introduced in April that deny epidural injections and nerve blocks reported together with any of the following procedures:

• Emergency intubation - 31500
• Insertion of non-tunneled central venous access/catheter - 36555-36556
• Insertion of arterial line - 36620-36625
• Insertion of Swan-Ganz catheter – 93503

Claims submitted prior to October 1st for these pairs of procedures will be erroneously denied by Medicare, if the services are performed between April and October. They will be payable retroactively to April 1st after October 1, 2009, thanks to ASA's efforts. (ASA challenged several other edits bundling conscious sedation codes with certain central and peripheral venous access codes; the NCCI contractor's response to these objections and its reversal of new edits affecting several other codes rarely performed by anesthesiologists is available on the ASA web site.)
Private payers may choose to use or ignore the CCI edits – or worse, they may create their own prohibited code pairs and perhaps not even disclose the edits before denying claims. One major private payer appears to be denying payment for fluoroscopy performed with pain procedures, and for anesthesia provided for a pain procedure performed by another practitioner. It also seems that payers recycle edits – they may give up the battle to enforce a particular edit only to revive the policy denying payment several years later.
The best solution for handling private payer code paid edits is to track them by payer and to challenge them, if your participation agreement doesn't provide for them. Adjust your expected collections accordingly. ABC constantly monitors claims for the emergence of new edits and appreciates clients' additional vigilance.
As for the CCI edits currently rejecting claims for pain procedures performed with the procedures described above, we will be noting clients' claims that need to be submitted, resubmitted or appealed after October 1st, and we encourage everyone to make sure that they ultimately receive the full payment to which they are entitled.
As always, we welcome your feedback. If you have a question about this topic or if you have another topic you would like discussed, please let us know.

 

[seinfeld]

This is how the Fed GVT will decrease cost of care by limiting accesss to it. As you all said medicare pts will end up getting the VA style anesthetic; GA ETT with morphine for post op pain, no epidurals (even in thoracic) and no blocks. I have thought for a while now that the VA should be where gvt insured pts get their care

The funny thing is that they wont limit access to care where it would save the most money, the end of life.

 

[hellothane]

Hey, if my coders are wrong and can appeal, hurrah!

 

[urge]

So you can say when an internal medicine doc is placing a patient on certain BP medication and doesn't work he shouldn't bill???
I totally disagree with the new reimbursement policy ( I didn't check yet with my billing company) - this is an intolerable interference in the practice of anesthesia.
Let's not pay anymore for an attempt for pancreatic resection because it was discovered during the procedure that the pancreas is not resectable...

You don't understand. I'm criticizing the Joe Schmos who hadn't done a block in 20 yrs and suddenly become the regional gurus when they realize they could double bill regardless whether the block works or not. Believe me there are many like that.

 

[Winged Scapula]

FWIW, CMS and others are still paying me for the intraoperative nerve blocks I do, although they have never paid for placement of an intraoperative "soaker" catheter like the On-Q. Be interested to hear if any of you can verify that you aren't being paid for your blocks.

 

[BLADEMDA]

You guys don't get reimbursed for blocks?

I thought blocks were anywhere from 6-10 units.

Why don't they pay you guys for them? What's the deal? Why do a regional fellowship?

What I am saying is that there seems to be a fairly high "Denial" rate for blocks. Even though we do a lot of blocks it is a far cry from a cash cow.

 

[MDEntropy]

You guys don't get reimbursed for blocks?

I thought blocks were anywhere from 6-10 units.

Why don't they pay you guys for them? What's the deal? Why do a regional fellowship?

For medicare, most blocks fall into the 3-4 'medicare unit' value range.