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Multiple pain blocks

Melissa Posted Thu 20th of June, 2013 20:02:06 PM

my anesthesiologist was in a procedure for a humerus fracture repair and tibial plateau fracture repair. I am using code 01740 because it is the higher base unit. Diagnosis code 812.20. My question is about the pre-op pain blocks. He did an interscalene "64415" and a femoral "64447". Can I bill both of these? I would use a modifier 59 for each, correct?

SuperCoder Answered Fri 21st of June, 2013 14:23:24 PM

CPT lists each of the continuous infusion nerve block codes within the anesthetic agent injection category, immediately following the code that describes an injection block of the same nerve. Example: Code 64416 is directly under the nerve block injection code for brachial plexus, single (64415).

Once you-ve found the proper code, be sure to keep reading through the descriptor. This tells you that you must include catheter placement and daily management for administering the anesthetic in the nerve block code.

Interscalene/Brachial Plexus Blocks – If general anesthesia is used for a shoulder case, and an interscalene block is placed for post-op pain, the block can be billed for separately with code 64415 (8 units). If a continuous interscalene block is placed instead of a single stick, then code 64416 (13 units) is billed. For continuous blocks, there is no longer a global period, meaning that you can bill for follow-up visits if you physically see the patient on a subsequent calendar day. The typical code billed for this service is “subsequent inpatient visit” code 99231 (2 units).
Femoral and Sciatic Nerve Blocks – If a general anesthetic is used for a knee case, and a femoral and/or sciatic nerve block is placed for post-op pain, then the block(s) can be billed for separately with codes 64447 (femoral – 7 units) and/or 64445 (sciatic – 7 units). If a continuous block is placed instead, then report either code 64448 (continuous femoral – 12 units) or 64446 (continuous sciatic – 12 units). Follow-up visits can be billed if applicable, as mentioned above with the continuous brachial plexus blocks.
In conclusion, it is imperative to indicate that your block is separate and distinct from the primary mode of anesthesia used in the case when billing for post-op pain procedures. For example, groups should not check off both “general” and “regional” as the modes of anesthesia unless they are truly intending to do a combined “general-regional” technique, which would negate the separate billing of the block. Although most payers will allow a post-op pain block to be used as an adjunct to a general anesthetic, if the block itself could have provided the entire anesthetic, then documentation of medical necessity for the “general” is recommended. Per CMS requirements, anesthesiologists should state clearly on the anesthesia record that the block is “for post-op pain per surgeon request”. Per the AMA, post-op pain blocks can be performed either pre-operatively, intra-operatively or post-operatively. However, post-op pain blocks performed prior to the induction of anesthesia are not to be included in billable anesthesia time and are billed as “flat fee” surgical procedures instead, per the ASA.

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