# can I bill general, spinal, & block together?



## vanessa10 (Apr 21, 2010)

For total knee replacements our Drs are doing general anesthesia, a spinal, and a continuous femoral catheter for post op pain. Can I code 01402, 62311, and 64448?? Someone is telling me that maybe we shouldn't bill for the spinal because it is part or the primary anesthesia.


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## hgolfos (Apr 22, 2010)

That depends on if your providers are using a combined anesthesia technique or if they are placing the spinal for post operative pain management.  If it's the former you can't bill it, if it's the latter you can.  My understanding is that the femoral block only provides pain relief for part of the knee, necessitating a combined pain control method.  Our physicians do femoral nerve blocks combined with IV/PCAs for total knee post op pain.  The best thing to do is consult your providers about the intent.


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## dwaldman (Apr 22, 2010)

From the NCCI Policy Manual
62310-62311, 62318-62319 (Injection of diagnostic or therapeutic substance):
CPT codes 62310-62311 and 62318-62319 may be reported on the date of surgery if performed for postoperative pain management rather than as the means for providing the regional block for the surgical procedure. If a
narcotic or other analgesic is injected through the same catheter as the anesthetic agent, CPT codes 62310-62319 should not be reported. Modifier 59 may be reported to indicate that the injection was performed for postoperative pain management, and a procedure note should be included in the medical record.

From CPT Assistant
It is appropriate to report pain management procedures, including the insertion of an epidural catheter or the performance of a nerve block, for postoperative analgesia separately from the administration of a general anesthetic. 

When general anesthesia is administered and these injections are performed to provide postoperative analgesia, they are separate and distinct services and are reported in addition to the anesthesia code. Whether the block procedure (insertion of catheter; injection of narcotic or local anesthetic agent) occurs preoperatively, postoperatively, or during the procedure is immaterial. 

If, on the other hand, the block procedure is used primarily for the anesthesia itself, the service should be reported using the anesthesia code alone. In a combined epidural/general anesthetic, the block cannot be reported separately. 

Examples

 A patient having total knee replacement surgery may receive a regional anesthetic and a postoperative pain management agent through the same epidural catheter, in which case the only code reported would be 01402.


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## vanessa10 (Apr 22, 2010)

I'm not sure that youre understanding the question. The Dr is doing general anesthesia, a spinal, and a continuous femoral nerve block. He specifies that the femoral nerve block is for post op pain but does not specify why he is doing the spinal. What i need to know is if the spinal is included in the 01402 or if i should bill 01402, 62311, and 64448.


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## hgolfos (Apr 22, 2010)

Vanessa, 

I wouldn't feel comfortable billing the spinal without verifying that it wasn't for a combined anesthesia technique.  Since your Doc didn't indicate this, you need to clarify, or don't bill it.  As I said above, the spinal could be either for post op pain *OR *combined technique.  You have to get more info, because it isn't automatically included in general anesthesia.


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## sandraboty (Apr 29, 2010)

the spinal should not be billed separately. the general and spinal or most likely the mode of anesthesia (included in 01402). the continuous block should be the additional charge. Spinals are not typically for pain management purposes, epidural are.


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## roz65 (Feb 7, 2011)

sandraboty said:


> the spinal should not be billed separately. the general and spinal or most likely the mode of anesthesia (included in 01402). the continuous block should be the additional charge. Spinals are not typically for pain management purposes, epidural are.



Agreed, totally!


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