IF YOU PERFORM PERIPHERAL nerve blocks for post-op pain in your ASC, there's a good chance that you may be able to receive a facility fee for at least some of them. If you're not currently billing for these, I recommend you start. Not long ago, I consulted with a facility that does about 4,000 orthopedic cases per year. They were not billing for the nerve blocks they administered. Changing that added $250,000 to their annual bottom line.
Here are some tips for seeking facility fee reimbursements for PNBs in your ASC:
- Someone other than the physician who performs the surgery must perform the block. The physical location where the block is delivered (i.e. the operating room vs. a dedicated block room) does not matter.
- The block must serve the sole purpose of post-op pain control. The patient must receive a primary form of anesthesia other than the block, such as general anesthesia or sedation. It's no problem, though, if the block enables the anesthesiologist to use a lighter form of primary anesthesia.
- There should be a procedure report for the block that is separate from the surgeon's operative report and the anesthesiologist's anesthesia record.
- Use a different claim form than you use for the orthopedic surgery, and bill it in the name of the anesthesiologist who performed the block. You do not need a -59 modifier on the code.
In my experience, some private payors will reimburse close to the amount you bill, others may pay $100 or less per procedure, and others won't reimburse at all. Interestingly, policies can differ among plans sponsored by the same payor, so don't presume that all Blue Cross policies, for example, provide the same block coverage for these blocks.
Two important notes. First, obviously, don't bill payors whose contract with your ASC specifically excludes PNB reimbursement. Second, don't try to bill Medicare separately for peripheral nerve blocks related to surgery. Medicare reimburses for PNBs, but only for chronic pain control as the only procedure performed (usually by Pain Management physicians). Since late 2007, Medicare has considered PNBs for post-op pain control part of the global surgery charge. You may not bill for them separately.
Many insurers now agree that peripheral nerve blocks are an excellent service to patients, and they are willing to compensate you for providing this service to their customers. All you have to do is ask.
Ms. Ellis is President of Ellis Medical Consulting, Inc., Brentwood, Tennessee.