Anesthesia Coding Alert

Question: Several carriers deny our claims for brachial plexus blocks or other peripheral nerve injections for post-operative pain management, even though we include the appropriate code for anesthesia during the procedure. We also included V58.89 and the surgical diagnosis. What should we be reporting?


Colorado Subscriber

Answer: Begin with the proper injection code: either 64415 (Injection, anesthetic agent; brachial plexus, single), 64416 (... brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic administration) or 64450 (... other peripheral nerve or branch), depending on the type of injection. All of these codes are considered components of most anesthesia codes in CPT. If your provider administers anesthesia during the procedure and performs the post-operative pain management injection, append modifier 59 (Distinct procedural service) to the injection code to indicate it is separate from the procedural anesthesia.

For the diagnosis, report an appropriate pain code as the primary diagnosis. Include V58.89 (Other specified aftercare) as the secondary diagnosis.