Anesthesia Coding Alert

Question: How should I code the anesthesia service for creating an AV fistula with a nerve block? The provider used ultrasound guidance.

Mississippi Subscriber

Answer: The appropriate anesthesia code is 01844 (Anesthesia for vascular shunt, or shunt revision, any type (eg, dialysis)). Report this code when the anesthesia provider has performed a preoperative evaluation of the patient and then induced the patient and monitored them while another physician performed the shunt procedure.

Code 01844 carries a base value of 6.

You should not bill the nerve block separately since you’re already coding for the anesthesia administration. You can, however, report +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)) since your provider used ultrasound guidance for the vascular access. Since the nerve block is the mode of anesthesia and not billed separately, your provider should be documenting and reporting the time it takes to place the nerve block whether it is continuous or discontinuous.