Post Op Pain Block

Medicare is denying all our 64450 codes done for Post Op Pain as not medically necessary and citing WPS LCD L35222
Local Coverage Determination (LCD):
Nerve Blocks for Peripheral Neuropathy (L35222)

We are appealing but getting denied again as 50-Non-cvd, not deemed med necessity.
N115 N115-Decision based on LMRP or LCD


Is anyone else having the same problem with WPS or any other MAC - is anyone getting pain for post op pain?

Comments

  • I haven't seen many denials. The ones I have seen are because the diagnosis on the LCD is not quite what was documented/reported.
  • I often bill for code 64415 which is also for post/op pain (on shoulders). I have only been denied by Medicare when I failed to put the diagnosis code for post/op pain: G89.18 and a specific code for the location of the pain (for example M25.512 for pain in left shoulder). Have you tried billing with those extra codes?
    ALSO, I use modifier 59 AND notate that no time was added for the block. My note for anesthesia time for the surgery plus the 64415 looks like this:
    1015-1230 = 135 MINS; 64415 NO TIME ADDED. I bill electronically and it goes through this way and we get paid.
    Then there is the ever important documentation: my anesthesiologist documents that the post/op pain block was requested by the surgeon and he documents the time separately for the block and the anesthesia time for the surgery and I believe, states the size of needle and drug used.
    Hope that helps!
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