Anesthesia Coding Alert

Question: We are an ASC billing for the facility side of claims. I'd like to know if we can bill 64415 when administered by the anesthesiologist after a shoulder arthroscopy procedure (such as 29827) and get paid for the anesthesia injection. Should we include modifier 59? I've been told to not bill this to Medicare, but what about private payers?

Connecticut Subscriber

Answer: The key when billing a postoperative pain block administered by an anesthesia provider is to have proper documentation. Your first step is to determine the type of anesthesia used during the procedure (29827, Arthroscopy, shoulder, surgical; with rotator cuff repair).

Option 1: If the mode of anesthesia was general, you need solid notes regarding several items:

 Documentation by the surgeon requesting that anesthesia perform the block

• Documentation in the anesthesia provider's notes that the surgeon requested the block
• Documentation that the block was used for post-op pain management
• Documentation of visualization, needle entry, and the pictures were saved/recorded in the record if ultrasound guidance was used.

Some insurers expect to see post-op pain blocks reported with modifier XU (Unusual non-overlapping service) or modifier 59 (Distinct procedural service). A diagnosis such as G89.18 (Other acute postprocedural pain) should be linked to the block.

Option 2: If the mode of anesthesia was MAC (monitored anesthesia care), none of the previous advice applies. The nerve block is not separately billable in conjunction with MAC, as the efficacy of the primary anesthesia is dependent on the block.