Anesthesia Coding Alert
Post-Op Block Can Take Place Before Surgery
Question: Our anesthesiologist’s notes documented:
Axillary nerve block w/ultrasound: 07:25-07:42
Anesthesia: 07:47-09:03
Do I bill all three codes (01830 for the anesthesia, 64417 for the block, and 76942 for the ultrasound)? Or do I just report the anesthesia code for entire length of time? I’m not sure how to handle it since he placed the block prior to the surgery.
Answer: First, check to see if your state has a Local Coverage Determination (LCD) for pain management. Also verify whether the block was separate from the anesthesia used for the surgery and whether it was requested by the surgeon for post operative pain management.
Resource: Pages 58 – 65 of the Relative Value Guide® (RVG) explain the American Society of Anesthesiologists recommendations, which are based on the National Correct Coding Initiative (NCCI) and carrier guidance. It is important to note that in the past two years there have been quite a few updates to the post operative pain management section of the NCCI, which have not yet been updated to the RVG.
Option 1: Presuming the regional block was separate from a general anesthesia utilized for the surgery and presuming the documentation supports the surgeon’s request and the separate ultrasound service, all three codes may be reported:
01830 – Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified
64417 – Injection, anesthetic agent; axillary nerve
76942 – Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation.
Note that time spent placing the block is NOT included in the anesthesia time.
Option 2: However, if the type of anesthesia utilized for the surgery was either regional or monitored anesthesia care (MAC), only 01830 and 76942 may be billed. The two blocks of time (17 minutes + 76 minutes) may be added together and reported under the discontinuous time allowance.
Minnesota Subscriber
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