Urology Coding Alert

Answer: If you chose to code both the prostate biopsy, 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach), and a separate nerve block (64400-64450) you may be asked to pay back Medicare for a mistaken reimbursement.

Practices may be getting paid for nerve blocks with procedures, but according to the CPT guidelines and Medicare policies noted in the May issue of UCA, this may not be proper coding behavior. The nerve block codes 64400-64450 are not bundled into many surgical procedures. Consequently, practices are finding that they can bill separately for both the procedure and any nerve blocks. But CPT Surgery Guidelines maintain that "local infiltration, metacarpal/metatarsal/digital block or topical anesthesia" is always included in the surgical package.

"Just because something is paid, does not necessarily mean that it should be," says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services.

Page says that both the CPT definition of Surgical Package and Medicare make it clear nerve blocks are included in the package when "administered for anesthetic purposes." She also reminds coders that Medicare "will not pay the surgeon for acting as the anesthetist and surgeon in the same session."