To apply for a diagnostic opinion and/or therapeutic pain management where a consultation is repeated for the same condition/problem within six months by the same consultant, or where in the judgment of the consultant, the consultative service does not warrant a 01016.
01016, 01116 do not apply to evaluation of pain during confinement.
Fee item 01116 plus a nerve block would be payable for the initial re-referral at the same sitting.
In cases where the consultant sets down a treatment plan that requires the patient to return to follow-up nerve blocks for the same condition, only the nerve block is payable.
In some cases, a single nerve block will be performed at the initial consultation and no further nerve blocks are planned at that time. The course of treatment is to monitor the effectiveness of the first block. If, however, the patient is re-referred for further blocks within 6 months, then a follow-up consultation (01116) plus the nerve block is payable.
The anesthetic fee is for professional services. Consultations (fee items 01016, 01116, and 01013) when requested, will be charged in addition. Anesthetic evaluation (fee item 01151), or Continuing Care items (fee items 01107, 01108) will not be charged in addition. These fees are for diagnostic and therapeutic procedures not associated with surgery.
Please reference the billing pre-amble for these relevant interpretations of this billing code:See Pre-Amble Notes