# 64415 interscalene block for post op pain management



## seslinger (Nov 17, 2016)

Hi we are an ASC billing for the facility and was wondering if anyone is billing the 64415 (giving by the anesthesia dr) preoperatively to a shoulder arthroscopy (ex. 29827) and getting reimbursed.  Are you billing with the -59 modifier since it is bundled ?  I hear we should not bill to Medicare but what about private payors ?

Any imput would be appreciated ... Sheila, CPC


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## donsgirl1015 (Apr 18, 2017)

what was your resolution?  we are having this debate currently....  thanks for sharing

melissa


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## missyah20 (May 25, 2017)

So the key here is to have proper documentation when billing a post op pain block that is done by anesthesia.  I am assuming with the shoulder surgery the mode of anesthesia for the procedure is General.  

I always tell me providers they need:

-Documentation by they surgeon requesting that anesthesia perform the block. (We have been successful when there is an order by the surgeon in the record.) (Must have esp if appealing with Medicare.)
- I reccommended that the anesthesia provider also notes in their documentation that the block was requested by the surgeon.
- Document the block as a separate procedure note. It is difficult to distinguish it as a separate procedure for insurances if it is documented on the anesthesia record.
- Make sure it is noted that the block is for postop pain management.
- If ultrasound guidance is used make sure to document visualization, needle entry, and note that pictures were saved/recorded in the record.   (United Healthcare is a stickler for having documentation of ultrasound image rentetion.)

We generally bill out post op pain blocks with an XU modifier unless you are billing Noridian Medicare and then they still want the 59 and won't pay with an XU.  You should be fine just using the 59 as well. We use diagnosis code G89.18 (I think thats the right code - I dont have my book with me currently.) to link to the block.

We don't see too many denials on this front and if you have everything documented you should be ok if you need to appeal. 

The NCCI offers some good guidelines on this.

Good Luck!


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## LisaAlonso23 (May 26, 2017)

It also depends on the primary anesthesia technique used. Those nerve blocks may only be billed with general anesthesia. 

If MAC is used, the nerve block is not separately billable, as the efficacy of the primary anesthesia is dependent on the block.


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## eguerrero (Mar 2, 2018)

*Po Op Pain Blocks*

missyah20,  per your info below, can you also tell me if the pain blocks should be billed with the other procedures peformed, or should it be billed on its own claim form?  I am getting two different responses from the coders.  I am asking for the facility billing of an ASC.  

also would like to know if on the same claim, would it be billed using the surgeon that performed the actual procedure or the anesthesiologist that did the block, for just the pain block.


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