Duramorph and post-op visit billing for c/s ?

[gasp]

Anyone here do their own billing or know the rules?
I'm a 1099 and we do a lot of c/s and use duramorph in the spinal for post-op analgesia. My question is can you bill for the duramorph injection? Also can you bill for a follow-up visit the next day?
I know it will be different for CMS and other private insurance. Any info on this would be appreciated.
I have heard lots of different things from anesthesiologists and also from different billing companies. Some say you can and some say no so i'm just trying to make sure I do things in a kosher fashion.

Ive looked on the forum but only found some old info from 2006 which did not help.

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[gasdoc77]

My understanding is that if the procedure is used in any way as the primary anesthetic, it cannot be billed for postop pain control (even if a long acting agent is added). This holds true for blocks as well. However, if you had to convert to g/a, you MIGHT be able to then bill the spinal as for "postop pain". I'm not sure. We would occasionally do hips under g/a (LMA) with a single shot duramorph spinal for postop pain (+/- a cc of bupiv just to paint the fence).
Those could be billed as being for postop pain.
Again, I've been in practices that used every technique you can imagine depending on that practices expectations.

 

[deleted162650]

Yes you bill for Duramorph but must have a documented post-op day f/u note. We get 7 units for the C/S and 3 uints for duramorph

 

[gasp]

This is exactly the problem. There are already 2 contradicting responses. gasdoc77 I have been told that before as well but I'm seeing colleagues do a single shot spinal with bupi + duramorph for c/s and bill for duramorph as post-op analgesia and also bill a post-op visit the next day just like SaltyDog says. Anyone else care to chime in?

 

[Noyac]

This is exactly the problem. There are already 2 contradicting responses. gasdoc77 I have been told that before as well but I'm seeing colleagues do a single shot spinal with bupi + duramorph for c/s and bill for duramorph as post-op analgesia and also bill a post-op visit the next day just like SaltyDog says. Anyone else care to chime in?

This is how we do it.

 

[Frank Rizzo]

Anyone here do their own billing or know the rules?
I'm a 1099 and we do a lot of c/s and use duramorph in the spinal for post-op analgesia. My question is can you bill for the duramorph injection? Also can you bill for a follow-up visit the next day?
I know it will be different for CMS and other private insurance. Any info on this would be appreciated.
I have heard lots of different things from anesthesiologists and also from different billing companies. Some say you can and some say no so i'm just trying to make sure I do things in a kosher fashion.

Ive looked on the forum but only found some old info from 2006 which did not help.

Our group has struggled with this. I went to the Anesthesia Billing and Practice Management Conference at Caesar's in Vegas last year and asked this very question. They said it was fraud to bill for both the spinal and duramorph since it is the same procedure. Obviously some attendees at the conference disagreed, but then the speaker produced examples of CMS coming down on two different groups for billing for both. Now, I fully understand that a conference like this will tell you the most conservative thing, but knowing that CMS audits are only going to get more ridiculous as time goes on, and seeing two groups already burned for it, we decided the chance of 10x damages was not worth the risk. We do bill 99231 for a follow-up visit, which seems to only actually get reimbursed about half the time.

On a side note, I probably haven't been to this site in about a year. I see some of the same old topics, but seeing some business/practice management stuff is interesting... may have to start lurking around again.

 

[somedumbDO]

Yes you bill for Duramorph but must have a documented post-op day f/u note. We get 7 units for the C/S and 3 uints for duramorph

This is also what our group does