Ob-Gyn Coding Alert

Question: We are a gynecology practice, and frequently do procedures in our office such as a LEEP (loop electrocautery excision procedure) compaction with a cervical block. Is it appropriate to add 64435 to the LEEP code for the cervical block? Or is the block on the patient considered part of the package of the primary procedure? Surgery guidelines in the CPT manual state that listed surgical procedures include blocks plus topical anesthesia.

Katie McClure, RHIA, Surgical Coder
Southeastern Gynecologic Oncology, Alpharetta, Ga.

Answer: According to CPT, the surgical procedure includes local and topical anesthesia as well as metacarpal blocks. Metacarpal blocks consist of injecting an anesthetic agent into the fingers. The definition of local anesthesia is anesthesia affecting a local area only, the anesthetic acting upon nerve or nerve tracts. In contrast, a regional block, which is not included in the surgical package as defined by CPT, is one in which the anesthetic causes a loss of feeling over a large area. In this case, 64435 (injection, anesthetic agent; paracervical [uterine] nerve) describes a paracervical nerve block in which the area around the cervix is injected with a local anesthetic to supply pain control. Some insurance companies will consider this to be a local and will deny the service, while others will classify it as a regional block and may pay for it. You will only find this out by billing for it the first time.

Note that Medicare and CHAMPUS do not pay the physician who has performed the surgical procedure for any anesthetic administration associated with the procedure. If you code for the paracervical block, you will need to add a modifier -51 (multiple procedures) to the code as the CPT multiple procedure rules apply in this case. The American College of Gynecologists and Obstetricians (ACOG) coding manual lists the injection of a local anesthetic (into the cervix) as part of the procedure.