# Anesthesia base units for continuous nerve blocks



## Jarant (Dec 6, 2010)

Was there a base unit change from ASA on continuous nerve blocks?  If so when and does anyone know where I can find this information?

Thanks Jenny


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## dwaldman (Dec 9, 2010)

I was able to find it in the ASA relative value guide. Please note the one I have is from 2008 I have not ordered a new one but need to. Below are base units that they list for the procedures in question.

62318---10
62319---9
64446----12
64448---12
64449--12


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## Jarant (Dec 13, 2010)

Thank you I have these.  Just one of my doctors had said that ASA is changing the base units for continuous nerve blocks.  I had not heard that.  Have you heard that?


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## dwaldman (Dec 13, 2010)

No I have not heard that, but aren't those blocks paid based on RVUs which are represented in a fee schedule amount versus base unit plus time x conversion factor. So even if the base units change according to the ASA, that does not necessarily mean the codes are going to be revalued on a fee schedule or RVUs changed.


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## dwaldman (Dec 13, 2010)

I am not sure if the link will work so I copy and pasted as much of the article as I could. I found this by typing 64448 into the ASA site at www.asahq.org but this article is not current and what your physician is talking about, there could be an article on this site if you could fiqure out the correct phrase to search under or browse what they have posted the past 30 or 60 days, but the searches I did were unsuccessful locating what he is mentioning.

http://www.asahq.org/For-the-Public...spx?_id=F49E22053E2847E9B30AC257DF92C0D1&_z=z

The Medicare program has received substantial criticism from organizations such as MedPAC, from members of Congress, and from some medical specialty groups that the agency has not adequately addressed overvalued services in the physician fee schedule. In response, the AMA Relative Value Scale Update Committee (RUC), created a standing workgroup to identify potentially incorrectly valued services through a number of statistical screens. To date, hundreds of codes have been reviewed and many have had their values adjusted. These adjustments have predominantly been reductions.
Changes in the Continuous Infusion Pain Codes: 


In the fall of 2007, the RUC Five-Year Review Identification workgroup identified several services as having site of service anomalies. Codes with a site of service anomaly are services that have hospital days included in the global period but according to the Medicare claims files are services performed as outpatient procedures more than 50% of the time. Global period procedures bundle all work associated with the procedure, including follow-up visits, into a single payment. These documented follow-up visits were included in the valuation for the continuous catheter codes from the time these codes were created earlier this decade. In fact, if the follow-up work is not performed, some payers require that the fee be diminished. All specialty societies with codes falling into site of service anomalies were asked to submit an action plan to the workgroup and RUC to explain this site of service discrepancy

Two of the codes that describe the placement and daily management of a continuous peripheral nerve catheter were identified as having a site of service anomaly. These codes had a 10-day global period. The RUC requested that the codes be re-surveyed with a zero day global. The codes were first presented to the CPT Editorial Panel so that their descriptors could be revised to facilitate this change. (Reference to daily management had to be deleted). In order to maintain consistency within the code set, the same process was applied to the two other continuous PNB codes.

CPT revised the descriptors for the following pain codes. The codes were then surveyed with a new global period of 000:
64416 - Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration
64446 - Injection, anesthetic agent; sciatic nerve plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration
64448 - Injection, anesthetic agent; femoral nerve plexus, continuous infusion by (including catheter placement) including daily management for anesthetic agent administration
64449 - Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration
These revised descriptors no longer include daily management. Postoperative daily visits will be eligible for separate reporting with an appropriate E&M (evaluation and management) code. 

The table below lists the current value for these codes with a 10 day global; the current value minus the hospital visits built into the 2008 010 global designation, the current 2009 recommended value with the new 000 day


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