Anesthesia Coding Alert

Question: Our anesthesiologist performed a suprascapular block injection while the surgeon performed a manipulation on a patient with complex regional pain syndrome. On the same day the anesthesiologist performed a stellate ganglion block on the same patient. He explained to me the suprascapular block was necessary as not to disturb her other condition. Can these both be billed together?

California Subscriber

Answer: You may be able to report 64418 (Injection, anesthetic agent; suprascapular nerve) with 64510 (Injection, anesthetic agent; stellate ganglion [cervical sympathetic]), using modifier 59 (Distinct procedural service) to show that a separate injection was performed.

You'll need to be able to prove medical necessity, so be sure to work with your anesthesiologist to provide the documentation you'll need.

As your anesthesiologist mentioned, local anesthetics are often injected in the area of the stellate ganglion in order to reduce symptoms from type I complex regional pain syndrome, also known as reflex sympathetic dystrophy. In addition, physicians may also use suprascapular nerve blocks to treat chronic shoulder pain.

-- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Kelly Dennis, MBA, ACSAN, CANPC, CHCA, CPC, CPC-I, president of Perfect Office Solutions in Leesburg, Fla.; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.