Anesthesia Coding Alert

Question: Our anesthesiologist was present during a bilateral knee replacement surgery. We coded 01402 for the anesthesiol­ogist’s service. The surgeon also asked that the anesthe­siologist administer bilateral continuous femoral nerve blocks. How should we code for the femoral blocks? I was told that we cannot include modifier 50 when billing for anesthesiologists. Is that true?

Missouri Subscriber

Answer: Yes, you were told correctly – you cannot include modifier 50 (Bilateral procedure) in conjunction with anesthesia codes such as 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty). You can, however, append modifier 50 as appropriate when you bill flat-fee/surgical services for your anesthesia providers.

There are different ways to report this case, depending on whether the block was used as part of the anesthetic or for post-operative pain management and the insurer’s guidelines:

• If the bilateral blocks were part of the anesthetic, you would only report 01402 with any applicable modifiers. If your provider documented the time it took to place the block, you can report the additional “discontinuous” time with your anesthesia time.
• If the bilateral blocks were for post-operative pain, you would report under one of the following scenarios:

o One unit of procedure code 64448 (with either a primary modifier 59 or one of the X modifiers to show the block was separate from the anesthesia) (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter [including catheter placement]) with secondary modifier 50 to show the procedure was performed bilaterally.

• Two units of 64448 (with either a primary modifier 59 or one of the X modifiers)
• Procedure 64448 (with either a primary modifier 59 or one of the X modifiers) and secondary modifier 50 on line one of the claim form and 64448 alone on line two. If you bill this way, list the same fee on both claim lines.

Because payers have different preferences, verify how the payer in question wants you to report the care before submitting the claim.