You Be the Coder:
Nerve Blocks After Surgery
Published on Fri Nov 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient had surgery for a foot abscess. The surgeon called one of the anesthesiologists from our pain team to administer a sciatic nerve block immediately after surgery was completed (the patient was still in the OR). Should we bill the surgical anesthesia as usual and the nerve block as a separate pain management procedure? What documentation is needed to support it? Should a modifier be appended to the block code?
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Answer: I assume that two anesthesiologists were involved with the case one to administer the pain block and one to provide anesthesia care during the surgery. If so, the pain management physician should document the surgeon's request for service and either dictate a short note or document the block administration in the progress notes. Bill it with 64450* (Injection, anesthetic agent; other peripheral nerve or branch) and a diagnosis of pain (such as 729.5, Pain in limb, for foot pain) rather than the code supporting the need for surgery. If two physicians from the same group provide the services, append modifier -59 (Distinct procedural service) to identify the sciatic nerve block for postoperative pain management as a separate and distinct service. If the physicians are from different groups or have different provider numbers, one bills the anesthesia service and the other bills the pain procedure (64445*, Injection, anesthetic agent; sciatic nerve). | |
