• Billing for Opioid-Free Anesthesia; Successes, Challenges and Lessons Learned

    The magnitude of the opioid crisis has caused widespread disruption in healthcare’s habitual, longstanding practice of using inexpensive and readily-available opiates as the “quick fix,” first-line treatment of acute and chronic pain. This epidemic and its far reaching, highly-publicized consequences highlight the new reality that those who can—but do not—actively combat the opioid epidemic are culpable in it. This new era has become the impetus for widespread adoption of opioid alternatives and practice change in the United States. Providing a route for billing for opioid-free anesthesia (OFA) incentivizes providers to change their practice away from opioid-based analgesia to pre-emptive analgesia. The more providers use and bill for OFA, the more pressure will be put on the healthcare insurance industry to fundamentally change reimbursement from inexpensive, readily-available and exceedingly high-risk opioids to non-opioid alternatives.

    As of yet, a CPT code for OFA does not exist, making it challenging to bill for this service. Although admittedly challenging, by using alternate coding, a “back door” provides a pathway for additional reimbursement for this critical service. Through a process of trial and error, some pearls of wisdom have been gained and are worth sharing. (1 Class A CE)