Anesthesia Coding Alert

Question: What procedure code applies to a popliteal fossa block in the ankle area for postoperative pain?

Nevada Subscriber

Answer: Check with your provider for more details before coding the procedure because the needle insertion location will help determine the nerve(s) blocked and the correct injection code.

Anatomy options: The sciatic nerve separates into the tibial nerve and common peroneal nerve slightly above the top of the popliteal fossa area. Potential codes include 64445 (Injection, anesthetic agent; sciatic nerve, single) or 64450 (... other peripheral nerve or branch).

ICD-9 includes specific diagnoses for postoperative pain management, so check the options in the 338.x series (Pain, not elsewhere classified).

Caution: The HIPAA-mandated ICD-9 guidelines state, "Routine or expected postoperative pain immediately after surgery should not be coded." If your provider administers the popliteal fossa injection to reduce expected postoperative pain, you might need to look at diagnosis codes for pain at the specific surgical site instead of relying on 338.x. In this case, a more specific diagnosis such as 719.47 (Pain in joint; ankle and foot) might be best.