Urology Coding Alert

Question: What code should I use for a prostate block?

New York Subscriber

Answer: You have two CPT Codes options for reporting a prostate block, and your choice depends on where the urologist administers the block and what carrier is involved.
 
If the urologist administers a pudendal block, you should report 64430* (Injection, anesthestic agent; pudendal nerve). But if the urologist administers a periprostatic block, you should report 64450* ( other peripheral nerve or branch).

You may need to append modifier -59 (Distinct procedural service) to 64450 depending on the corresponding procedure the National Correct Coding Initiative edits bundle 64450 into most prostate procedure codes including 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) and some minimally invasive prostatic BPH treatment codes (53850, Transurethral destruction of prostate tissue; by microwave thermotherapy; 53852 by radiofrequency thermotherapy; and 52647, Non-contact laser coagulation of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]).

In a recent policy issued by the American Urological Association (AUA), the AUA does not advocate billing for local anesthesia for needle biopsies of the prostate it considers anesthesia administered by the urologist included in CPT's definition of the surgical package and not a billable service.

Many carriers, Medicare included, will not reimburse for a periprostatic block. Check with your local carrier to determine whether its policy includes local anesthesia in the surgical package or if it is separately billable.

  Answers to You Be the Coder and Reader Questions 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 19-urologist practice in Indianapolis.