Anesthesia Coding Alert

Question: Our anesthesiologists are using ultrasound guidance when administering postoperative nerve blocks after total knee replacement surgery. We have a written request from the surgeon for the nerve block and the ultrasound guidance. We are billing the following: 27447, 64447-59, and 76942-26. Medicare is denying the claims as “not medically necessary.” Can you help us with this?

New Hampshire Subscriber

 Answer: Coding edits classify 64447 (Injection, anesthetic agent; femoral nerve, single) as a Column 2 code for 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]). You are not allowed to bill these codes together under any circumstances, even if you append a modifier such as 59 (Distinct procedural service).

Your final claim should include 27447 and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation) with modifier 26 (Professional component).

If your provider is only reporting anesthesia for the procedure, you would submit 01402 (Anesthesia for open or surgical arthroscopic procedures on knee joint; total knee arthroplasty). It has a base unit value of 7.