Anesthesia Coding Alert

Question: The anesthesiologist administered a Bier block during a carpel tunnel release. Do we report this in addition to the case's anesthesia code? If not, when should we use 01995?


Wisconsin Subscriber

Answer: Do not report Bier blocks separately. The surgeon will report 64721 (Neuroplasty and/or transposition; median nerve at carpal tunnel). Because your physician administered the Bier block as the primary anesthesia during the procedure, you will report 01810 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursa of forearm, wrist, and hand). If the anesthesiologist used general anesthesia during the procedure and administered the Bier block for post-op pain, however, you would bill 01810 for the procedure and 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with modifier 59 (Distinct procedural service) for the post-op injection.
 
Anesthesia coders rarely use 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]) because you report services according to the procedure performed rather than the type of anesthesia given. However, some carriers (such as Kentucky Medicare) state that you should report 01995 for anesthesia during a carpal tunnel procedure instead of 01810. You might also report 01995 if the physician uses a Bier block as part of a chronic pain patient's treatment therapy instead of as anesthesia.

When you do report 01995, remember it is a flat-fee procedure and does not reimburse for the physician's time. Check the carrier's local policy to ensure you code it correctly.