Q:  When a post op pain block is billed, should the appropriate anesthesia modifier be added as well, such as AA, or one of the Q modifiers if one of those are applicable?
A:  No, the CPT codes used for post op pain blocks and ancillary services when done separately from your ASA codes, are not reported with Anesthesia modifiers.

Q:  For those CPT codes that were mentioned that have a “separate procedure” designation in CPT, should we add a modifier such as 59 or one of the X modifiers?
A:  Yes, per the Surgery Guidelines for separate procedures in our CPT books, when a “separate procedure” is carried out independently or considered to be unrelated or distinct, it may be reported by appending modifier 59 (or Xx depending on carrier guidelines).

Q:  Occasionally we have a case where the block is performed intraoperatively. Do we need to deduct that from their time spent?
A:  No, when the post-operative pain procedure is placed after anesthesia induction or prior to emergence (intraoperatively), the time spent performing the block is not deducted from the total anesthesia time.

Q:  Do we have to have a written order for a postop pain block?
A:  A written order and/or some sort of written documentation is required showing that the surgeon requested the anesthesia team to participate in the post-operative analgesia.