Urology Coding Alert

Question: Will insurance companies cover code CPT 64430 when we're administering Verapamil? I billed the insurance company 64430, 54200 and J3490 for Peyronie's disease.


Vermont Subscriber

Answer: You won't likely receive reimbursement for 64430 (Injection, anesthetic agent; pudendal nerve) from carriers that follow Medicare guidelines. Medicare will never reimburse for anesthesia because they include anesthesia in the surgical package.

The Medicare guidelines also clearly indicate that anesthesia administered by the surgeon (in your case, the urologist) is considered part of the surgical CPT code. Therefore, you shouldn'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.

Alternative: However, some private carriers will pay for the anesthesia a surgeon administers prior to the performance of the procedure. 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.

For a private carrier, bill for the anesthesia until you determine which carriers will and which carriers will not reimburse for this service. 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.

Pointer: When coding for administration of anesthesia, add modifier 47 (Anesthesia by surgeon) to the surgical (not the anesthesia) procedure code indicating that the surgeon will make an anesthesia charge in addition to his surgical charge and code.