Reader Question:
Append -47 to Prostate Block for Some Private Payers
Published on Sat Oct 30, 2004
Question: We have been billing CPT 64450 for the prostate block when we do a prostate biopsy, but we don't always get paid. Are we coding incorrectly?
Michigan Subscriber Answer: Medicare will not reimburse for any anesthesia that the surgeon may administer. Don't try to bill for any type of anesthesia charges for a Medicare patient whether the anesthesia administered is for a diagnostic or a therapeutic procedure.
However: Several (but not all) private carriers will reimburse for the anesthesia charges. If a private carrier does not follow Medicare policy and does not define the surgical package as including anesthesia, you can bill for the anesthesia as a separate charge. Use 64430 (Injection, anesthetic agent; pudendal nerve) for a pudendal nerve block, and use 64450 (Injection, anesthetic agent; other peripheral nerve or branch) for a periprostatic block.
Some carriers, following CPT rules, require you to append modifier -47 (Anesthesia by surgeon) to the procedural code, not the anesthesia code, indicating that the surgeon will make an anesthesia charge in addition to his surgical charge and code. - Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 21-urologist practice in Indianapolis.
