Urology Coding Alert

Question: Our physicians have started using a prostatic block for prostate biopsies. Can we bill any type of anesthesia code, or is it included in the global?

Michigan Subscriber

Answer: It depends on the location of the block and the patient's carrier. Report code 64430 (Injection, anesthetic agent; pudendal nerve) for a pudendal nerve block, and code 64450 (Injection, anesthetic agent; other peripheral nerve or branch) for a periprostatic block.

Exception: Medicare and many local carriers will not reimburse for prostatic blocks. And NCCI bundles 64450 into most prostate procedure codes, including 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). If a carrier allows billing, you may need to append modifier -59 (Distinct procedural service) to 64450 to break it from the bundle.

The American Urological Association and Medicare frown on separate billings for nerve blocks, and in general Medicare will not reimburse for any anesthetic service administered by the operating surgeon or urologist. However, since CPT does not specifically mention regional nerve blocks in the definition of the "global surgical package," some private carriers may reimburse for these anesthetic codes.