Pain management question...

If a orthopedic surgeon places a pain line intraoperative, but the anesthesiolgist is the one to manage the pain after surgery. Who would bill for that? The surgeon or the anesthesiologist?

I asked this question to our coding compliance department. This is what they said...

"If the code for the placement includes daily monitoring then they should both bill, the surgeon with mod 54 & the anesthesiologist with a mod 55. If it does not include for the daily monitoring then the surgeon would bill for the placement and the anesthesiologist should bill using E/M codes if there is not a monitoring only code."

I dont know if I agree with this. I would love to hear everyone's opinions. Thank you

re: Pain management question...

Epidural drug administration for a hospital patient, 01996 (daily management of epidural or subarachnoid drug administration),may be paid by Medicare after the day the anesthesiologist inserted the catheter.
But in case mentioned, the surgeon inserted the catheter. In this case, the anesthesiologist time for daily management of drug administration can begin the same day and be billed with 01996. Pain management is part of the surgeon's global period but separate reimbursement may be made when the surgeon requests in writing that the anesthesiologist manage the patient’s in-hospital postoperative pain because---------------.

re: Pain management question...

Additionally, the "placement of the pain line intraoperatively" would not be separately billable by the surgeon, whether with modifier 54 or globally.  It is typically considered an inclusive part of the surgical package reported by the surgeon.  Medicare is quite clear on this and for the most part placement of a "pain line" by the surgeon is considered to part of the CPT® Surgical Package definition.  
 
The bigger issue that I see though is what is the medical necessity to have anesthesia manage the "pain line" if the surgeon has the skill set to place the line?  In my opinion, this scenario creates increased risk for payer review.  E/M services reported by the anesthesiologist post-operative are on several of the RAC approved issues lists.  As we know, Medicare is very clear regarding this in the CCI manual:
Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon.  The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner.
IF there was truly medical necessity with documentation to support it, then the anesthesiologist would use either the 01996 or one of the 9922X codes to report their post-operative pain management services.  The 01996 would only be used if the "pain line" was an epidural or intrathecal continuous infusion.