Anesthesia Coding Alert

Question: One of our pain management physicians performed an exam of a patients extremely painful knee under IV sedation to determine the cause of the pain. After the patient recovered from the exam, the physician performed a sympathetic block under fluoroscopy. How should the initial exam be coded?

Idaho Subscriber

 
Answer: Based on whether the patient was new or established and what type of documentation you have for the procedure, you could code an appropriate E/M service. Other options include billing with 27599 (unlisted procedure, femur or knee) or 27570* (manipulation of knee joint under general anesthesia [includes application of traction or other fixation devices]) and appending modifier -52 (reduced services) because it was not performed under general anesthesia.