Anesthesia Coding Alert

Question: When a code specifies requiring anesthesia and the physician does a Bier block, is the physician able to bill for the Bier block separately, or is that included in the original code?

South Carolina Subscriber

Answer: Anesthesia is reimbursed by calculating a unit value. This unit value consists of a start-up charge plus time. The charge for anesthesia services depends on the CPT code used to define the start-up service (this will specify the start-up unit value) and the amount of time that the patient was under the care of an anesthesiologist
(1 unit = 15 minutes in most areas).

An anesthesiologist providing care during a carpal tunnel release (64721, neuroplasty and/or transposition; median nerve at carpal tunnel) would use the Medicare code 01810 (anesthesia for all procedures on nerves, muscles, tendons, facia and bursae of forearm, wrist and hand), which has a three-unit start-up value. If the procedure takes 30 minutes to perform, it would be charged as three base start-up units + two time units for a total of five units. Since the service is what is compensated and not the type of anesthesia, this would be the reimbursement calculation whether monitored anesthesia care (MAC), general anesthesia or a Bier block is used.