Health Information Management

Do not separately report pain injections at the conclusion of an operation

APCs Insider, October 28, 2005

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Do not separately report pain injections at the conclusion of an operation

QUESTION: According to the July 1998 and October 2001 issues of the American Medical Association (AMA) publication CPT Assistant, it is appropriate to report postoperative nerve blocks when performed to control postoperative pain. However, does this hold true for joint injections (20600-20610) performed at the conclusion of a procedure when administered for post-op pain management? Please refer to the examples in operative reports A and B.

Operative report A: Is it appropriate to code 20600 for the anesthetic finger joint injection following the synovectomy/joint resection?

Operative report B: Is it appropriate to code 20610 for an injection of pain medication into the knee joint following a knee arthroscopy?

The American Academy of Orthopaedic Surgeons 2005 Web site states that "Generic intraoperative services include local infiltration of medications, anesthetic, or contrast agent, before, during or at the conclusion of the operation."

Therefore, after researching numerous knee procedures and other types of orthopedic procedures, we concluded that we cannot report injections into the incision or joint at the conclusion of the procedure for pain management. We concluded that the only type of injection we can code--per the July 1998 and October 2001 issues of CPT Assistant--is a nerve block (i.e., 64415). Please advise us based upon the above information and enclosed operative reports A and B.

ANSWER: Based upon the operative reports you provided, which include "injection of Marcaine into the knee joint," the intraoperative drug injections performed at the conclusion of the operation are considered inclusive components of the respective surgical procedures, and therefore you cannot report them separately. Do not report 20600-20610 for the pain injection provided intraoperatively. Refer to the July 1998 and October 2001 issues of CPT Assistant for proper reporting of nerve blocks only (i.e., for intrascalene nerve blocks for pain management during a shoulder surgery, use CPT 64415). (Source: AMA).



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