Anesthesia Coding Alert

Question: Our physician performed a celiac plexus block on a patient with pancreatic cancer. He says these  are normally administered in two stages but that he likes to perform them in one day. He inserts two needles on either side at L-1, administers a local anesthetic and leaves the needles for about 15 minutes. If the block helps the patient's pain, he administers alcohol through the needles to destroy the nerves. Is this one procedure or two, and how should I report it?


North Dakota Subscriber

Answer: Your physician is correct: Most providers perform a celiac plexus block (64530, Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring) and monitor the patient's pain relief for a day or two. If the initial block succeeds, the physician then performs a permanent block (64680, Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus).

Your situation is different because the physician is performing both services on the same day. Before you can charge for two separate injections on the same day, the physician must administer them separately. That means he must insert the needles twice - not insert them once and leave them until later.

Because the physician placed the needles once, you should code it as one procedure. Report 64680, which has a 20-unit base value and a 10-day global period (in this case, 64530 is considered bundled into the neurolytic destruction.)