Anesthesia Coding Alert

Question: How should I code an interscalene block administered prior to general surgery for rotator cuff surgery? Another provider performed the block before anesthesia induction. I coded it as 23420 (Reconstruction of complete shoulder [rotator] cuff avulsion, chronic [includes acromioplasty]) and reported 64415* (Injection, anesthetic agent; brachial plexus, single) with modifier -59 (Distinct procedural service) on the second line, but the carriers denied it.

Wisconsin Subscriber
 
Answer: Accurately reporting these types of cases is difficult because Medicare has bundled so many nerve block codes. First determine if the physician performed the interscalene block or if "another provider" placed the block for post-op pain. If another provider placed the block, you can't bill for it; you can only bill for the anesthesia service. However, if your physician performed the block, you can code for it and get reimbursed. Start by documenting the surgeon's request for the block and notes stating that the block was for post-op pain and not intended as the mode of anesthesia.
 
Once you've determined that you can code for the block, most carriers will accept 64415-59. Be sure to report Type of Service "02" (Surgical service); if you filed with Type of Service "07" (Anesthesia service) instead, that could explain the initial denial.
 
If you're able to code for both services (the block and general anesthesia) it might help to submit them separately. Report 64415-59 on the second claim, using shoulder pain as your primary diagnosis (V58.9, Unspecified aftercare, with modifier -59 for Medicare patients; or 719.41, Shoulder pain, for other carriers) and V58.49 (Other specified aftercare following surgery) as the secondary diagnosis. Reporting the block separately helps distinguish it from the procedural anesthesia and will make it easier to appeal if necessary.
 
Check your local Medicare carrier's Web site for its latest LMRP for postoperative pain. This should give you a list of diagnosis codes that support medical necessity for the procedure so you can ensure you're complying with their guidelines.