Wiki billing 43775 with 64488

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maddalynni

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Hello,

I work in a multi-specialty coding environment, but the 2 busiest are OB/GYN and General Surgery. One of the OB's says we should bill 64488 Transversus bilateral abdomins plane anesthetic block with his surgeries when applicable and most payers aren't paying, even with 59 modifiers. So we tried with Lap sleeve gastric bypasses with our General surgeons and we are getting the same results. Does anyone have any input on this subject? The blocks are being done by the surgeons. Most of my research says we shouldn't bill for it when the surgeons are doing them. Any thoughts???
 
NCCI does not allow separate reimbursement for anesthesia performed by the surgeon doing the procedure, and these policies are followed by most payers.

This is addressed in several place in the NCCI Manual, Chapter 1, 'General Correct Coding Policies':

Examples of services integral to a large number of procedures include...Local, topical or regional anesthesia administered by the physician performing the procedure.

Medicare Anesthesia Rules prevent separate payment for anesthesia services by the same physician performing a surgical or medical procedure....If it is medically reasonable and necessary that a separate provider (anesthesia practitioner) perform anesthesia services (e.g., monitored anesthesia care) for a surgical or medical procedure, a separate anesthesia service may be reported by the second provider.

Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure. For example, separate payment is not allowed for the physician’s performance of local, regional, or most other anesthesia including nerve blocks if the physician also performs the medical or surgical procedure.

Based on the above, 64488 bundles to most major procedures in the CCI edits, and cannot be overridden with a modifier.
 
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