Orthopedic Coding Alert

Version 9.0 of the Correct Coding Initiative (CCI), which took effect on Jan. 1, bundles 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration]) into most musculoskeletal system codes (those in the 20000-29999 range).

The AMA's CPT Changes 2003, An Insider's View suggests that the CPT committee introduced 64416 to aid coding when physicians perform postoperative pain management, and offers the example of a patient who had a traumatic thumb and forefinger amputation and requires pain relief.

The new edit, however, bars physicians from billing 64416 with the finger and thumb amputation codes (26910-26952), as well as most other surgical procedures. On the other hand, the edit features a "1" indicator, so coders can append modifier -59 (Distinct procedural service) in the rare case when the continuous infusion is unrelated to the surgical procedure.

If a separate physician, such as a pain management specialist or anesthesiologist, performs the nerve block, he or she can bill separately for it because it would not be included in the global package. Only the surgeon who performs the original procedure would be barred from billing the "bundled" code during the global period.

CCI 9.0 also bundles the code for single brachial plexus nerve block (64415) into many orthopedic surgical procedures, such as 29827 and 29899 (Arthroscopy ...), although practices can append modifier -59 to override these edits as well if both services are separate and medically necessary.