Orthopedic Coding Alert

CPT 2003 introduces four new somatic nerve block codes, eliminating the need to bill an additional anesthesia code when administering continuous infusion for orthopedic pain management.

The new CPT also revises several injection code descriptors in the 20550-20605 range, most notably referencing the number of trigger point muscles injected, rather than "muscle groups" as in 2002. Continuous Infusion Nerve Block Codes Unveiled The four new nerve block codes will eliminate existing ambiguity, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver: "In 2002, the AMA instructed practitioners, 'Do not select a CPT code that merely approximates the services provided. If no such procedure or service exits, then report the service using the unlisted procedure or service,' therefore mandating use of the unlisted codes for infusion catheter pain management procedures." The new codes are:

64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration

64446 ... sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration 64447 ... femoral nerve, single

64448 ... femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. "Outpatient practices will probably report 64447 more frequently than the other new codes," Hammer suggests. As a single nerve block code, orthopedists might offer it to patients who require pain management to help tolerate physical therapy following procedures such as ACL repair. "In the outpatient setting, I could foresee 64447 being used as a diagnostic tool to evaluate possible femoral nerve injuries," Hammer says. The continuous infusion codes (64416, 64446 and 64448) will have more applications in postoperative pain management. Prior to 2002, orthopedists probably reported these procedures using 64450* (Injection, anesthetic agent; other peripheral nerve or branch) and 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). Some practices may have submitted a code in the 99231-99233 range (Subsequent hospital care ...) for the follow-up management of the infusion catheter.  "The second code is no longer necessary, since the new code descriptions clearly state 'including daily management for anesthetic agent administration,' " Hammer says. "The new codes carry a 10-day global period, and the instructions specifically indicate that 01996 should not be reported." Case Scenarios for New Nerve Block Codes The AMA's CPT Changes 2003: An Insider's View suggests you might use 64416 for postoperative pain relief and vasodilation following traumatic amputation and surgical reimplantation of a patient's thumb and forefinger. "The surgeon often requests continuous catheter pain management not only to control pain but to allow for earlier postoperative therapy to the affected sites," Hammer says.  Likewise, you might report [...]