​Statement on Reporting Postoperative Pain Procedures in Conjunction with Anesthesia

Developed By: Committee on Economics
Last Amended: October 15, 2025 (Original Approval: October 17, 2007)

Placement of neuraxial and peripheral nerve blocks for post-operative pain control (post-operative pain procedures) is separate and distinct from surgical anesthesia services. Valuations for anesthetic codes do not include the work of performing post-operative pain procedures and payment for them should not be bundled with that of the anesthetic service. These post-operative pain procedures may be reported in conjunction with an anesthesia service when certain specific conditions are met. A key consideration is clear recognition of the difference between a regional anesthesia technique that is performed as the primary surgical anesthetic versus a regional anesthesia procedure that is intended primarily for postoperative analgesia. The latter may be separately reported and claimed regardless of when they are administered in the perioperative period. (See Medicare Claims Processing Manual, Chapter 12, Section 50 Subsection F (Issued: 04-14-17; Effective: 01-01-17; Implementation: 05-15-17) and the National Correct Coding Initiative Manual for Medicare Services, Chapter 2 Section B Subsection 4 (Revision Date 2/28/2024). 

A postoperative pain procedure may be reported as a service separate from the anesthetic if the postoperative pain procedure is employed primarily for postoperative analgesia and if the following conditions apply:

1. The anesthesia for the surgical procedure was not dependent upon the efficacy of the regional anesthetic technique
   For example, if a femoral nerve block is placed prior to knee arthroplasty to provide post-operative analgesia, then a general or neuraxial anesthetic would have to be used as the primary anesthetic for the actual knee surgery. 
2. The time spent on pre- or postoperative placement of a block is not included in reported anesthetic time 
   Postoperative pain procedures are frequently placed before anesthesia start time or after anesthesia end time. When the block is placed before the anesthesia start time or after the anesthesia end time, the time spent placing the block should not be added to the reported anesthesia time; this is true even if sedation and monitoring are provided to the patient during the performance of the postoperative pain procedure. When the postoperative pain procedure is placed in the operating room after anesthesia start time and prior to anesthesia end time, the time spent performing the block is not deducted from the total anesthesia time. 

One method for describing that the primary purpose for the block is to provide postoperative analgesia is to dictate or record details about the procedure in a separate document in the medical record from the anesthetic record. When documenting, it is important to discuss that: 

1. The surgeon requested the provision of postoperative analgesia by the anesthesiologist. Some payers may require the specific documentation of this request by both the surgeon and/or the anesthesiologist. 
2. The patient participated in the discussion regarding the most appropriate plan for postoperative analgesia.
3. Distinct informed consent must be performed for the planned postoperative pain management intervention, including providing the patient with specific information about the risks and benefits of the proposed therapy.