Anesthesia Coding Alert

Question: The charge ticket reported bronchoscopy and upper endoscopic biopsies because of an upper esophageal mass. The anesthesiologist noted, “MAC.” At the bottom of the same page (for the same date of service) he wrote, “nerve block.” Should we bill for both the anesthesia and the nerve block? Do we need modifier 59?

New Jersey Subscriber  

Answer: The anesthesia record should have more details about the care, so code based on that information instead of the charge ticket.  

Begin with 00520 (Anesthesia for closed chest procedures; [including bronchoscopy] not otherwise specified) for the bronchoscopy. Append modifier QS (Monitored anesthesia care) if the record shows that the anesthesiologist used MAC, and modifier AA (Anesthesia service personally performed by anesthesiologist). 

Next, check whether the physician placed the nerve block as part of the procedure’s anesthesia or for postoperative pain management. If the block was part of the anesthesia, you won’t bill for it. If, however, the block was administered for post-op management, you can report it with modifier 59 (Distinct procedural service). Confirm that you have additional details such as who requested the block, for what purpose, when the block was placed, and the insertion point. CPT® includes multiple codes for nerve blocks, so verify the type of block placed so you can choose the correct code.