Orthopedic Coding Alert

Question: One of our surgeons occasionally bills for a femoral block when he does a total hip replacement, but Medicare denies the block as not medically necessary. Is there any way to get paid for the service?

Florida Subscriber

Answer: No, your surgeon won't receive separate reimbursement for 64447 (Injection, anesthetic agent; femoral nerve, single) following the hip surgery (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft).

Here's why: The global surgical package includes postoperative pain management such as a femoral block. Although an anesthesia practitioner might be reimbursed for postoperative pain care in certain circumstances, the same isn't true for surgeons. The Correct Coding Initiative (CCI) manual states, "Postoperative pain management by the physician performing a surgical procedure is not separately reportable by that physician."