How to bill for regional anesthetic techniques continues to pose some confusion.The purpose of the regional technique determines the method for submitting the claim for reimbursement.


When the regional anesthetic technique is administered and used as part of the primary anesthetic it is billed using anesthesia time and reimbursed in the same manner as a general anesthetic with the base units + time multiplied by the local conversion factor formula.  The time spent on the placement of the block prior to induction may be added to the case’s anesthesia time.  The two blocks of time are submitted for reimbursement.


“Reporting Postoperative Pain Procedures in Conjunction With Anesthesia,” is guidance published by the ASA that clearly lays out how to report the service to third party payers if the regional anesthetic technique is used for post-operative pain relief.


The general rule for billing the block for post-operative pain relief is listed in the ASA guidance:


“A provider may bill for a regional anesthetic technique as a service separate from the anesthetic if the regional technique is employed primarily for post-operative analgesia and the following conditions apply: the anesthesia for the surgical procedure was not dependent on the efficacy of the regional anesthetic technique and the time spent on the pre- or post-operative placement of the block is separated and not included in the reported anesthesia time.”


Post-operative regional anesthetic techniques are billed as an additional service provided the same day as surgery and reimbursed separately with a flat fee.  Documentation should show the purpose of the block and that it was performed for post-operative pain relief at the surgeon’s request.  Documentation of the surgeon request for the pain management shows medical necessity for the block.


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