Anesthesia Coding Alert

Question: How would you code this case that included discontinuous time?  

Type of Anesthesia Checked:  TIVA, Regional, MAC

Tennessee Subscriber

Answer: You may not have a case of discontinuous time as much as a case of two different anesthetics being administered. Begin by verifying whether the axillary block was part of the anesthetic, or used for postoperative pain management after the surgery.

Option 1: If the anesthesiologist placed the block for post-op management, report it with 64417 (Injection, anesthetic agent; axillary nerve), without time. Although there is documentation to support 20 minutes of time, time is not reported separately or applicable to this procedure code. Append modifier 59 (Distinct procedural service) and include diagnosis code 338.18 (Other acute postoperative pain). Also report 01810 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand) for 33 minutes of anesthesia time during the carpal tunnel surgery.

Option 2: If documentation doesn't clearly support the axillary block as separate from surgical anesthesia or the axillary block was the mode of anesthesia, code the entire case as regional anesthesia. Report 53 minutes of time for code 01810, which includes the 20 minutes of block placement time plus anesthesia time during the carpal tunnel procedure.