Anesthesia Coding Alert

Question: The anesthesiologist placed a single-injection intrathecal block to interspace L2-3 during an inguinal hernia repair (49650). I know that if general anesthesia was given for this particular surgical case the anesthesia code would be 00840. How do I report the service since it was an intrathecal block instead?

Vermont Subscriber

Answer: You are correct that the appropriate anesthesia crosswalk code for an inguinal hernia repair 49650 (Laparoscopy, surgical; repair initial inguinal hernia) is 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified). Since the surgery was for an inguinal hernia repair and services are not reported by the mode of anesthesia, you will still report 00840.

The difference would be if a general anesthesia was used for the surgery and a single-injection intrathecal block to the lumbar spine 62322 (Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance) is used as postoperative pain management.  In that case, you would be able to report the nerve block with a modifier 59 (Distinct procedural service) or one of the “X” modifiers that described the particular situation.  For example, if one anesthesia provider placed the block and another provided anesthesia for the inguinal hernia, an XP modifier (Separate practitioner) better explains the circumstances. If the nerve block had only been used for postoperative pain management, you could bill it separately with diagnosis G89.18 (Other acute postprocedural pain).

However, the block is not separately billable in this situation because it served as the primary mode of anesthesia during the procedure. The only time a block is separately billable is when it’s documented for postoperative pain and the primary anesthesia during the procedure is general. Blocks may not be billed when regional or monitored anesthesia care (MAC) is the primary mode of anesthesia. What you can capture, if the time was discontinuous and as long as the anesthesia provider documented when the block was placed, is the time it took to place the block.  If there was not a gap in time, your anesthesia provider can begin anesthesia time with the placement of the single injection.