Anesthesia Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: How should I code for a single interscalene block performed under monitored anesthesia care (MAC) prior to general anesthesia? The anesthesiologist administered general anesthesia for the surgery and the interscalene block for post-op pain management. Do we have to document that the patient wanted the block and general anesthesia for the surgery? Do we bill differently for a single-shot interscalene block with a catheter insertion for later post-op pain control? Massachusetts Subscriber

Answer: As with any pain block administered for postprocedure pain control, the anesthesiologist must document the request because Medicare includes pain relief in the global surgical fee (which means the surgeon is responsible for postoperative pain management).

Use 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]; other than the prone position) to report the MAC service during the nerve block. Code the initial interscalene block with 64415* (Injection, anesthetic agent; brachial plexus, single). Report CPT 64416 ( brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) for post-op pain management. This new code has a 10-day global period.