# Pain Nerve Blocks



## cayoung

Our anesthesiologists are performing pain nerve blocks (PNB's) in the post-op recovery area of our ASC.  In addition, an ultrasound machine is used for guidance.  I would appreciate your assistance with two questions:

1.  May both the anesthesiologists and the facility bill for the PNB – CPT codes 64415, 64417, 64445, and 64483? 

2.  May both bill for the ultrasound guidance - the anesthesiologists (76942-26) and the facility (76942-TC)? 

Thank you for your assistance.


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## magnolia1

Question #1---No

Question #2---Refer to #7 on the attached website.

http://www.medac.com/index.php/news...liance-billing-a-reimbursement-clarification-

****Copy & Paste into Address box


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## magnolia1

Let me clarify on #1---only the anesthesiologist can bill for this.


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## mbort

I disagree...DEPENDING  strictly on documentation, the ASC may possibly capture the blocks with appropriate documentation but it MUST be in addition to the primary anesthesia used.  Please see this CPT assistant:

Year: 2001 

Issue: October 

Pages: 9 

Title: Anesthesia and Postoperative Pain Management 

Body: Coding Clarification

The following article builds on information originally presented in the February 1997 CPT Assistant article, "Anesthesia: Coding for Procedural Services."

Codes for procedures commonly used in the management of postoperative pain include 62318 and 62319 (both introduced in CPT 2000) for continuous epidural analgesia and the series of codes for somatic nerve blocks (64400-64450).

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.

• A femoral nerve block (64450) placed to provide post-operative analgesia for an anterior cruciate ligament repair or a total knee replacement would be reported separately from the surgical anesthesia.

• A patient undergoing a thoracotomy might receive an epidural injection of a local anesthetic and/or narcotic (62318) for postoperative pain control in addition to the general anesthetic, which is administered through an endotracheal tube (00540). In this case, the epidural is not the surgical anesthetic and it would be reported separately, as an independent procedure.

• Shoulder surgery could be performed under an interscalene brachial plexus block that would also provide postoperative analgesia. This would be reported using the anesthetic code (eg, 01620). If the block were intended primarily to alleviate postsurgical pain, and a general anesthetic was administered for the shoulder procedure, the block would be separately reportable using code 64415.
• A brachial plexus block might also provide both the anesthesia and the postoperative pain control for an open reduction of a wrist fracture. Only the anesthesia code would be reported.


Â© 2005 American Medical Association


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## Jamie Dezenzo

I would agree w/ mbort.


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## martnel

mbort said:


> • A femoral nerve block (64450) placed to provide post-operative analgesia for an anterior cruciate ligament repair or a total knee replacement would be reported separately from the surgical anesthesia.


Please help me understand something here.... I thought femoral block was 64447? Hmmm? Now I'm confused!


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## mbort

martn said:


> Please help me understand something here.... I thought femoral block was 64447? Hmmm? Now I'm confused!



It is, the code has changed since this was written in 2001


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## cayoung

Thank you for the assistance!!


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## troberts33

*CCI Edit 1/01/09 nerve blocks w/anesthesia*

Effective 1/1/09 for facilities there are now CCI edits for reporting nerve blocks with general anesthesia.  Is it still appropriate to follow what the CPT Assistant listed here recommends then?


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## AYCPC

Karen, Can you please summarize the article you refer to in your message? The website is no longer available. I was just asked the same question today by one of my physicians. Thanks!


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