ASA Post-operative Pain Procedure Updates & Guidelines
by By Nicole Jasken, Billing & Coding Manager
As expected, the New Year always brings in changes & updates along with it. Updates we’d like to highlight are the changes the ASA has made to the way postoperative pain procedure (POP) units are reported & calculated. The units for these procedures will no longer be based off the base unit value assigned, rather it is being calculated using a WRVU (work relative value unit), similar to other surgical. For example, in 2019 procedure code 64415 is valued at a base unit value of 8; in 2020, this code is valued at a WRVU of 1.35. We are not anticipating a change in the reimbursement rates of these codes.
There were also a few block codes that have been deleted and new codes added. The following codes have been deleted effective 1/01/2020:
• 64402 – injection, anesthetic agent; facial nerve
• 64410 – injection, anesthetic agent; phrenic nerve
• 64413 – Injection, anesthetic agent; cervical plexus.
According to AMA instructions, we are to use 64999, which is an “unspecified code” in place of these deleted codes; which will require documentation for billing.
The following are new codes that have been added, effective 1/01/2020:• 64451 – injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance
• 64454 – injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance
• 64624 – destruction by neurolytic agent, genicular nerve branches including imagine guidance, when performed
• 64625 – radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance
As always, RC McLean & Associates strongly recommends following the “Post-operative Pain Guidelines” for correct reporting and documentation when these procedures are performed. POP’s are separately reportable and payable when documented accurately. Don’t let improper documentation “block” your payment for these procedures!
RCM Post-operative Pain Guidelines
- Important key POP practice reminders:
- Time spent placing these blocks should not be included in the reported anesthesia time.
- POP blocks should be documented on separate reports (when available), otherwise it should be clearly noted on the anesthesia record
- It is critical that the reason for the block is noted specifically “per surgeon request” and specific site of pain