Anesthesia Coding Alert

Question: Our anesthesiologists are performing nerve blocks with ultrasound guidance for post-op pain relief. Can we bill for an interscalene nerve block with an AV Fistula? Should we use 36821, 64415-59, or 76942-26? CCI edits shows bundling of 64415 with 36821.

Indiana Subscriber

Answer: No, you cannot bill code 64415 (Injection, anesthetic agent; brachial plexus, single) for an interscalene block in this case.

As you note, CCI edits list 64415 as a Column 2 code for 36821 (Arteriovenous anastomosis, open; direct, any site [e.g., Cimino type] [separate procedure]), meaning that the service of 64415 is part of 36821. You cannot report both codes together under any circumstances, not even with a modifier (such as 59, Distinct procedural service) to “break” the edit. As a CCI check states, “These codes cannot be billed together in any circumstances.” Therefore, you should report 36821.

CCI does not include an edit for 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) with 36821. Include 76942 on the claim and append modifier 26 (Professional component) to indicate your provider’s work.