# ASC question



## dbri806411 (Jan 19, 2009)

Hello everyone. I hope there are some coders with some ASC
knowledge 
cause I have some questions. I code for an ambulatory surgical
center 
in Montgomery, Alabama. I bill for the procedures only. The 
anesthesialogist bill for their services seperatley. One of the 
anesthesialogist came to be and was asking if there was any
component 
of continous cath blocks for post op pain (64446, 64416, 64449)
that 
we as the ASC could charge for and be covered. My office manager
does 
not think that we can charge for this and that it is included in
the 
procedure. I think differently since this is continous and for
post 
op pain management. Can anyone give me some guidance on this?
Thank 
you so much for your help.

Darlene Britton, CPC
Montgomery, Alabama


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## mbort (Jan 19, 2009)

I have never had the continuous cath blocks, BUT I can tell you that things such as interscalene blocks and such are reportable with a procedure note from the anesthesiologist as long as the block was in addition to the general anesthesia.


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## dbri806411 (Jan 19, 2009)

Thank you.  I need to find it in writing somewhere for my manager.


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## mbort (Jan 20, 2009)

I can send you the CPT assistant that references the interscalene type blocks if you'd like.


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## dbri806411 (Jan 20, 2009)

Oh that would be so helpful.  Speaking of the CPT assistant...is this a book or a monthly publication and where can I get one?  Do you wanna fax # or email?
Thank you again so very much !!


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## mbort (Jan 21, 2009)

this is put out by the AMA..I believe they have it in book, software and online versions.

Here is the link:

http://www.ama-assn.org/ama/pub/category/11249.html

I sent you a private message as well.


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## Jamie Dezenzo (Jan 21, 2009)

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 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.



• 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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