Anesthesia Coding Alert

Question: Our anesthesiologist performed anesthesia services on a patient and provided a femoral block for postoperative pain. All of this happened on the same day. What is the most appropriate way for me to code the femoral block?

Montana Subscriber

Answer: Because your anesthesiologist performed a single injection, your best coding option for this procedure is 64447 (Injection, anesthetic agent; femoral nerve, single).

Also, your provider performed anesthesia services on the same patient on the same date as the femoral block, so you will need to append modifier 59 (Distinct procedural service) to the femoral injection code to indicate that the block was separate and distinct from the anesthesia service.

Bonus info: If your anesthesia provider had inserted a catheter for a continuous femoral nerve infusion rather than the single injection, your coding choice would be 64448 (... femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration).

Remember: When your anesthesiologist performs a continuous femoral nerve infusion using a catheter -- under identical same-day circumstances -- you'll still need to append modifier 59.

Experts weigh in: You need to be sure your documentation meets certain requirements for post-operative pain. These include ensuring that the procedure was requested by the surgeon -- who was unable to provide the postoperative pain management -- and showing that the block was clearly separate from the anesthesia provided for the surgery.

One more thing: Note the time when the anesthesiologist performed the block. The AMA's May 2007 CPT Coding Assistant states, "If a nerve block or epidural is performed for the purpose of postoperative pain management and not as part of the anesthesia for the surgical procedure, then it too is reported separately. When these procedures are performed before the start of anesthesia time, the time spent on them should not be added to the reported anesthesia time because they are separate and distinct from the anesthesia service. If the procedure is performed after induction of the primary anesthetic, it is not necessary to deduct the time spent on the procedure from reported anesthesia time."