Anesthesia Coding Alert

Tip: 64450 might be the best bet for some less common procedures Making your way through pain management coding can be tricky, especially if your specialist performs some of the less common procedures, such as nerve injections into the wrist or ankle area. End your coding quandary by following our experts' advice.
Search by Nerve, Not Anatomy CPT lists nerve injection codes based on the nerve or nerve plexus your provider injects, not the general anatomic location (such as the ankle). Because of this, jump-start your coding success by encouraging providers to document the specific nerves they inject or anesthetize. Why this helps: The better your physician's documentation is, the better you can pinpoint the most accurate code. Realize, however, that your best option might still be a general code such as 64450 (Injection, anesthetic agent; other peripheral nerve or block) if nothing else applies. Caution: Sometimes coders focus so much on reporting a specific procedure code that they report detailed -- but incorrect -- codes. That can be the case if you're tempted to report a specific code such as 64447 (... femoral nerve, single) for an ankle block. "A coder cannot compliantly report a specific nerve injection code (such as femoral or sciatic) if the physician actually performs the injection on distal branches with different anatomic names," says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver. "That's the case for a pain management injection in the ankle area."
Ankle Choices Hinge on Procedure An ankle injection essentially blocks the distal branches of the sciatic and femoral nerves. Correct coding depends on the procedure and the reason for the injection. Surgical selection: If you're coding for anesthesia during ankle or foot surgery, report a code such as 01462 (Anesthesia for all closed procedures on lower leg, ankle and foot), 01464 (Anesthesia for arthroscopic procedures of ankle and/or foot) or 01470 (Anesthesia for procedures on nerves, muscles, tendons and fascia of lower leg, ankle and foot; not otherwise specified), depending on the case. Post-op possibility: If you're coding postoperative pain management for foot or ankle surgery, however, your coding options change. "Use the CPT code for the block administered (if it was not part of the anesthesia) and add modifier 59 (Distinct procedural service) with the appropriate diagnosis code for pain management," says Scott Groudine, MD, an anesthesiologist in Albany, N.Y. "In this case, you'll do best to code an ankle injection with 64450-59."
Clarify Before Coding 'Wrist Block' If your provider documents "wrist block" on the chart, your first line of action is to clarify the procedure. Here's why: The phrase "wrist block" covers a lot of territory. Providers often write "wrist block" [...]