Anesthesia Coding Alert

Question: Is it OK to bill a femoral nerve block if the patient receives general anesthesia for a knee arthroscopy? Should you append modifier -59?

New York Subscriber

Answer: Although performed with increasing regularity, this procedure is still so new that many coders dont know whether payment will be approved or denied. As long as the femoral nerve block was administered for postoperative pain management only, you can bill 64450* (injection, anesthetic agent; other peripheral nerve or branch) with modifier -59 (distinct procedural service). A pain diagnosis such as pain in extremity (729.5, pain in limb) may help. Be sure your documentation supports the use of the block for postoperative pain, not the surgery. An operative note accompanying the block reconfirms to the carrier that the block was a separate surgical procedure and not part of the anesthetic.