Anesthesia Coding Alert

Question: What's the best way to handle billing for the time associated with starting a block before surgery (and before general anesthesia for the surgery)? Should we report it as continuous or discontinuous time?

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Answer: How you bill block time depends on how well your physicians document their work, what your group decides is its usual policy, and why the physician performed the block.
 
If the physician administered the block for the patient's comfort during the procedure or postoperatively, the block is considered part of the surgical anesthesia and should be included as such. You can code the block as a separate procedure if the anesthesiologist administers the block before surgery and for a different reason, in which case you should use the appropriate injection code, such as 64415*, Injection, anesthetic agent; brachial plexus, single, for a brachial plexus block.
 
Some groups choose to bill the block's time separately from anesthesia during the procedure - this is discontinuous time. Other groups back up the case's start time to include when the anesthesiologist placed the block (for example, back up the case start time by 20 minutes if that's how long it took to administer the block). Remember that you can only add the block placement minutes to the total anesthesia time if the physician administered the block before the anesthesia start time of the case. If he places the block after beginning surgical anesthesia, it's part of the procedure's time.
 
Regardless of the coding route you choose, remember that you either code the block as a separately billable procedure or include it in the main procedure's time units - you cannot do both.