Anesthesia Coding Alert

Question: I read that I should report 01995 for Bier blocks instead of 90780. Which option is better?

North Carolina Subscriber
 
Answer: Correct Bier block coding partly depends on the block's purpose. Begin by verifying that the physician used the block for post-op pain control instead of the mode of anesthesia during surgery. When the physician uses it as the mode of anesthesia, you'll code based on the procedure itself, not according to the type of anesthesia used.
 
Some coders report 90780 (Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour) for Bier blocks. Other coders, however, say 90780 is inappropriate for a Bier block because of CPT's note stating, "These codes are not to be used for intradermal, subcutaneous or intramuscular or routine IV injections." A Bier block falls into this category because the physician targets the nerves instead of accessing the patient's bloodstream.
 
If the physician administers the block for postoperative pain control, some coders prefer 64450 (Injection, anesthetic agent; other peripheral nerve or branch) instead of 90780.
 
However, many coders believe that 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) most accurately describes a Bier block. If you decide to submit 01995 for the block, note three keys to reporting this code: The physician must administer regional anesthesia, he must use IV administration, and he must administer the injection to one of the patient's extremities.