Episode Summaries
BlockHeads aims to build a strong community of emergency medicine experts who share best practices and helpful tips for adopting ultrasound-guided regional analgesia in the emergency setting. To that end, we will regularly share summaries from our monthly Zoom meetings to highlight key points.
If you find these topics interesting and would like to get involved, we would love to have you join us at our next meeting!
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Emergency Medicine & Anesthesia Collaboration
Episode Topic: Emergency Medicine & Anesthesia Collaboration
Recently, a group of us from emergency medicine and anesthesiology got together to discuss a topic that's critical for our patients: pain management. We all know that effective pain relief is a cornerstone of good patient care, but it's also something that can be challenging to get right, especially in the fast-paced ER environment.
Why Collaboration Matters
We talked about how both emergency medicine and anesthesiology bring unique skills to the table when it comes to pain management. By working together, we can provide more comprehensive, efficient, and cost-effective care for our patients. It's a win-win-win!
Benefits We Identified
Improved Patient Care: A collaborative approach means we can consider a wider range of pain management options and tailor treatment plans to individual patient needs.
Increased Efficiency: Streamlining communication and processes between our specialties can help us get patients the pain relief they need faster.
Reduced Costs: Avoiding duplicate services and unnecessary procedures can help lower healthcare costs for everyone.
Challenges to Overcome
Of course, we also acknowledged that collaboration isn't always easy. We discussed some of the potential hurdles, like:
Turf Wars: We need to break down any perceived competition between our specialties and focus on our shared goal of providing excellent patient care.
Scheduling Conflicts: Coordinating schedules between busy ER docs and anesthesiologists can be tricky, but it's essential for effective collaboration.
We're excited about the potential of this collaboration to improve pain management for our patients. Stay tuned for updates as we move forward!
Remember: Pain management is a team effort. By working together, we can make a real difference in the lives of our patients.
Episode Topic: Billing and Coding
This newsletter provides a concise overview of Dr Vlasica’s discussion of billing and coding considerations for nerve blocks performed in the ER setting.
CPT Codes:
Specific CPT codes exist for most nerve blocks (e.g., brachial plexus block). Many of these codes now include ultrasound guidance.
Use separate CPT codes for blocks with dedicated codes.
For blocks without specific codes, use a generic code (e.g., 64450) but expect lower reimbursement.
Ultrasound Guidance:
Since 2023, ultrasound guidance is included in most nerve block CPT codes. You cannot bill a separate code for it.
Facility vs. Professional Fee:
You cannot bill a facility fee if you use your own handheld ultrasound machine.
You can bill a professional fee for performing the block using ultrasound for guidance.
Telephone Follow-Up:
Reimbursement depends on the payer's policy (e.g., Medicare does not cover it).
Document the call in the patient's record using an E/M code (9441-9443) even if not reimbursed.
2023 E/M Coding Changes:
Bill for POCUS exams (point-of-care ultrasound) using separate CPT codes for better reimbursement compared to including them in E/M coding.
Challenges and Best Practices:
Track your billing and reimbursement to identify areas for improvement.
Improper claim submission can lead to low reimbursement for POCUS exams.
Work with your revenue cycle department to optimize POCUS billing.
Avoid including proposed CPT codes in your documentation as it may not reflect the actual service.
CPT Codes20552 Trigger point 1-2
20553 Trigger point 2-3
64400 Trigeminal nerve branches
64405 Greater occipital nerve
64450 Lesser occipital nerve/ OTHER
64505 Sphenopalatine ganglion block
64413 Superficial cervical plexus
64415 Brachial plexus
64417 Axillary
64421 Injection intercostal nerves multiple regional block, Erector spinae
64447 Femoral nerve
64445 sciatic nerve
64461 paravertebral paraspinal block
64486 transversus abdominis plane
64488 rectus sheath block
64999 Unlisted procedure, nervous system
By understanding these key points, ER doctors can ensure proper billing and coding for nerve blocks, maximizing their practice's revenue while delivering high-quality patient care.