Anesthesia Coding Alert

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."

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."

Here's why: The phrase "wrist block" covers a lot of territory.

Why the crossover: The carpal tunnel is a canal in the wrist that is bound by bones on three sides and a fibrous sheath on the fourth. The median nerve -- along with nine tendons -- passes through this canal/tunnel. Any decrease in the tunnel's size (whether from compression or inflammation) can compress the contents. Common symptoms of median nerve compression include numbness, tingling, and pain in the patient's fingers and thumb (known as carpal tunnel syndrome, 354.0).

Although the physician might document his service as a wrist block because of the proximity, you should actually code the carpal tunnel injection with 20526 (Injection, therapeutic [e.g., local anesthetic, cortico-steroid], carpal tunnel).

Note: For more on coding carpal tunnel diagnosis and treatment, see "Recoup Reimbursement for Long-Term CTS Treatment" in January 2007's Anesthesia & Pain Management Coding Alert.