There are many reasons why the use of these nerve blocks has increased so dramatically. Many would argue that the use of these blocks minimizes the use of opioids and other anesthetic agents in the management of these cases, which is an entirely desirable outcome given the national opioid crisis. Others might also argue there is an economic benefit, as well—where such blocks are used exclusively for postoperative pain control. Given the current clinical and economic opportunities, then, the question is whether anesthesia practices are optimizing the use of these blocks.
There are three criteria to be considered when determining how to get the most out of the “block potential” within your practice. First, there are the requirements and preferences of the surgeon. Second, one must consider the documentation requirements of the payers. Third, what is the accuracy and consistency of the claims adjudication process? Let’s take a look at each of these in turn.
Surgical Consideration
Not all surgeons are proponents of nerve blocks, although younger orthopedic surgeons tend to be more enthusiastic than their older colleagues. The concern is usually that the administration of the block will delay the start of the case. From a compliance perspective, it is critical that the surgeon has agreed that the anesthesia provider will be performing a nerve block for purposes of postoperative pain management and that the reasons for transferring postoperative pain management over to the anesthesia team is documented in the surgeon’s record.
Typically, there are specific surgical procedures for which nerve blocks are considered appropriate. The following are common examples. Femoral and interscalene blocks are the most common.
Anesthesia Documentation
The anesthesia record must clearly confirm three things for each postoperative pain block to be billable. First, it must provide the details of the block (e.g., who placed it, time it was placed, single shot or continuous catheter, anatomical location, etc.). Second, it must reflect that the block was performed at the request of the surgeon. Third, the record must also confirm that the block is not the primary mode of anesthesia or used to augment the primary anesthetic; that is, the block was strictly used to manage postoperative pain.
Our coding staff will always confirm that these criteria have been met before submitting a claim for the block. It will, therefore, behoove the anesthesia provider to rigorously ensure each of these elements is sufficiently reflected within the anesthesia record.
Payer Adjudication
Even with proper documentation, claim approval is not always guaranteed. Some payers may still reject block claims for various reasons, including:
- Requests for additional documentation
- Modifier or coding issues
- Bundling/inclusive edits
- Authorization or referral concerns
The encouraging news is that most of these rejections can be successfully resolved through timely follow-up and attention to detail. With strong documentation practices and a proactive billing approach, anesthesia groups can improve claim outcomes and ensure appropriate reimbursement.