Anesthesia Coding Alert

Question: What procedure and diagnosis codes should I submit for femoral or interscalene postoperative blocks?


Minnesota Subscriber

Answer: The term "interscalene" describes the approach used for a brachial plexus injection. Physicians often use this type of block to control the patient's pain following surgery on the shoulder or upper and lower arm.

Look to 64415 (Injection, anesthetic agent; brachial plexus, single) or 64416 (... brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) for the interscalene block, depending on whether your physician administers a single injection or places a catheter for infusion.

Your physician may use femoral nerve blocks to control postoperative pain following anterior thigh or knee surgery. Report a single injection with 64447 (... femoral nerve, single) or continuous infusion with 64448 (... femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration).

The correct diagnoses depend on the patient's circumstances and your carriers' guidelines. Start by checking ICD-9's new pain code section 338.xx. Most postoperative situations call for 338.18 (Other acute postoperative pain). Report this as your primary diagnosis and include a secondary diagnosis code that explains where the patient has pain.

Example: If the patient is recovering from treatment for a fractured foot, report 338.18 as the primary diagnosis and 719.47 (Pain in joint; ankle and foot) as the secondary. You can also submit 825.2x (Fracture of other tarsal and metatarsal bones, closed) or 825.3x (Fracture of other tarsal and metatarsal bones, open) or V45.89 (Other postsurgical status) as a third diagnosis, but your carrier might not require it.

Final note: Some carriers only accept the new pain diagnoses with 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]). Check your carrier's policy guidelines for acute postoperative pain management before submitting codes from 338.xx; you might still need to report V58.49 (Other specified aftercare following surgery) in order to stay within the carrier's guidelines (and assuming that V58.49 applies to the service your physician provided).