Urology Coding Alert

Don't write-off anesthesia

The American Urological Association (AUA) advises against it. Medicare won't reimburse you for it. Are there circumstances when you can report anesthesia separately from the procedure itself? Yes, says Michael A. Ferragamo, MD, FACS, assistant professor of urology, State University of New York, Stony Brook.
 
In a policy it recently issued, the American Urological Association 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 it includes local anesthesia in the surgical package or if it's separately billable.
 
"Any anesthesia administered by the operating surgeon is included in the operative fee," Ferragamo says. "That means when you inject around the prostate for a prostate block - a regional area is blocked off - your anesthesia injection is included in the fee for the needle biopsy of the prostate."
 
You have two CPT codes for reporting a prostate block, depending on where the urologist administers the block and what carrier is involved.
 
If the urologist administers a pudendal block, you should report 64430* (Injection, anesthetic 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 bundles 64450 into most prostate procedure codes including 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) and some minimally invasive benign prostate hyperplasia treatment codes (53850, Transurethral destruction of prostate tissue; by microwave thermotherapy; CPT 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]).
 
Medicare and the AUA policy disapprove of separate reporting for a periprostatic block, but there are a few opportunities for payment, Ferragamo says.
 
"The CPT surgical package definition includes in the package local anesthesia, finger and toe block, and topical anesthesia. There's no mention in the surgical package definition of a block, what I call a regional block."
 
In fact, recently the CPT Assistant (see inset) presented a patient undergoing a circumcision and receiving a penile ring block at the base of the penile shaft and/or a dorsal penile nerve block with Marcaine. CPT indicated that this [...]