FEBRUARY 3, 2026
Originally published by our sister publication Anesthesiology News
Anesthesiology News presents its inaugural installment of a series that will explore real issues in anesthesia business. “Money Matters” will cover the latest updates in financial news, and serve as an independent resource for new guidelines, billing and coding models, and compensation trends.
LAS VEGAS—One of the most consequential, and confusing, aspects of anesthesiology is how to ensure that billing is
Originally published by our sister publication Anesthesiology News
Anesthesiology News presents its inaugural installment of a series that will explore real issues in anesthesia business. “Money Matters” will cover the latest updates in financial news, and serve as an independent resource for new guidelines, billing and coding models, and compensation trends.
LAS VEGAS—One of the most consequential, and confusing, aspects of anesthesiology is how to ensure that billing is conducted properly.
During a session held at the 2025 annual meeting of the ASA, experts offered a detailed look at how anesthesiologists can optimize documentation, coding, and collaboration in order to safeguard revenue and compliance in regional anesthesia programs.
Clarifying the Fine Print
In the first presentation, Jerry Jones, MD, of East Memphis Anesthesia Services, in Tennessee, discussed the key distinctions that can separate compliant billing from costly mistakes.
A first—and most critical—distinction, Jones said, is the intent of the block.
“If a peripheral nerve block is billed separately from anesthesia, it must be performed for postoperative pain control or another distinct indication,” he said. “The adequacy of the intraoperative anesthetic cannot depend on the peripheral nerve block.”
This underpins many billing denials. A block initially documented as “for postoperative pain” cannot be the primary anesthetic without invalidating its separate billing. Conversely, when a block is truly performed for postoperative pain, it must be clearly documented as such—with the correct modifier 59 and a surgeon’s order or note confirming the request.
To better understand the particulars of billing, Jones encouraged anesthesiologists to think of billing terminology as its own dialect.
“A ‘popliteal block’ isn’t a billing term,” Jones said. “Someone will say “I did a popliteal block” and hand it off to their coders, and it’s not a thing.” The correct terminology, Jones noted, is a sciatic (popliteal approach) nerve block.
“Using precise CPT [Current Procedural Terminology] language in your note—ideally even listing the code—can save you an RVU [relative value unit] or two on every case,” he added. And mislabeling, he added, is one of the simplest ways practices lose money.
Jones also addressed the ever-shifting coding landscape. Until recently, many newer blocks—such as IPACK (infiltration between the popliteal artery and capsule of the knee) or certain fascial plane techniques—fell under the unlisted 64999 code, a category that left reimbursement unpredictable.
This is finally changing. “As of January 1, 2025, there are four new CPT codes for thoracic fascial plane blocks, which now include ultrasound guidance,” Jones said.
Billing for ultrasound is also complicated and frequently misunderstood.
“Guidance is bundled into most block codes,” Jones said. “You only bill one ultrasound per case, and you must have a retrievable image and a brief description of what you visualized: needle placement, local anesthetic spread, or avoidance of structures.”
Equally important is understanding anesthesia start and stop times.
“Anesthesia time begins when you assume care and ends when you transfer care, not when the patient enters or leaves the OR,” Jones said. Continuous presence matters: A block placed in pre-op and followed directly into the OR counts as billable anesthesia time, but a gap—say, stepping away for coffee—does not.
Finally, Jones pointed to the Non-Opioids Prevent Addiction in the Nation Act, which aims to increase access to nonopioid treatments and allows separate payment for certain nonopioid pain management services in outpatient and ambulatory surgery center settings.
Partnering With Billing Professionals
During the next presentation, Gary Schwartz, MD, the co-director of AABP Integrative Pain Care and Wellness, in New York City, focused his attention on the necessity of process and teamwork.
His overall message? Clinicians should not go it alone.
“Regional anesthesia billing is detail-oriented and high risk,” Schwartz said. “A little extra work up front can save you enormous headaches later.”
Schwartz recommended close, ongoing collaboration with both in-house and contracted billing professionals in order to align templates, train staff, and identify errors as early as possible. For instance, at AABP, the anesthesia group meets quarterly with its billing company and hosts an annual grand round devoted to documentation and new codes.
“Every July our staff turns over, so by August or September we do a full in-service,” he said. This includes reviewing anonymous examples of cases were denied in order to study and learn from potential errors.
Standardizing templates across sites and electronic medical records is important, as is ensuring that each required element is captured correctly. Key fields should include laterality, technique, nerve targets, medications used, catheter details with start/stop times, and ultrasound documentation—including the image itself.
“Make your notes almost idiot-proof,” Schwartz said. “One saved image per block, stored in PACS (picture archiving and communication system) or the cloud, with a short statement explaining why ultrasound was used.”
First-pass denials, Schwartz warned, are the silent killers of efficiency. Sometimes payors give very little time for appeals to be processed, so if a claim is bounced back due to something simple—such as missing laterality or no evidence of real-time imaging—it may be difficult, if not impossible, to recover that payment.
At AABP, such issues are addressed by embedding surgeon-request checkboxes in accounting standards codification workflows and using payor-specific “cheat sheets” that list what insurers cover certain blocks.
Schwartz also recommends that institutions conduct mock audits several times per year.
“Pull a random sample of your regional cases and review them with your billing team,” he said. “Make sure everything is good and everyone is compliant, and if you get a real audit, you’re prepared to deal with it.”
Overall, Schwartz urged anesthesiologists to track operational metrics with the same rigor they apply to clinical ones. His group reviews key performance indicators monthly, including days in accounts receivable, clean claim rate, net collection rate, and denial rate.
“Billing is an extension of the perioperative team,” he said. “When you measure it, you improve it.”
By Ethan Covey
Jones reported receiving consulting fees from B. Braun Medical, Cal Tenn Innovations, and PAJUNK Medical Systems, and royalties from a patent titled Ultrashield Devices and Methods for use in Ultrasonic Procedures (publication number: 20170128042). Schwartz reported owning stock in Dorsal and receiving consulting fees from Pacira Pharmaceuticals.
