Anesthesia Coding Alert

Just because the Bier block is one of the most commonly performed regional anesthesia techniques doesn't mean it's always coded correctly or that coding for it is easy.But coding for the Bier block also called intravenous regional anesthesia becomes easier if you know what service the anesthesiologist performed. If you combine that with a sound understanding of your carriers' coding preferences, you can successfully code Bier blocks and receive appropriate reimbursement.Ask Pain Management or Surgical Anesthesia?Bier blocks use tourniquets to allow targeted anesthesia delivery to an extremity. Using tourniquets means that anesthesia providers typically use Bier blocks for procedures that last less than an hour, says Cindy Clark, anesthesia coding supervisor with the physician group Anesthesiology Consultants in Savannah, Ga. That's so the blood supply isn't cut off too long or the tourniquet pain does not get too severe.Your first step in correctly coding a Bier block is determining whether it was used during a surgical procedure or for pain management. Consider the following scenarios for times when Bier blocks might be used and how you should code the procedures:During a wrist ganglion excision The surgical procedure is 25111 (Excision of ganglion, wrist [dorsal or volar]; primary) with diagnosis code ICD-9 727.43 (Ganglion, unspecified). You would report the block with CPT 01810 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand) because it is used as anesthesia during surgery.During surgery to repair a fractured radius Report the anesthesia with 01820 (Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones) if it is a closed repair, or use 01830 (Anesthesia for open procedures on radius, ulna, wrist, or hand bones; not otherwise specified) for an open reduction internal fixation of the bone.During a pain management procedure for conditions such as reflex sympathetic dystrophy (RSD) When an anesthesia provider administers a Bier block for pain management, report it with 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]). The purpose of the block in this case is to treat a chronic pain syndrome, not to provide anesthesia for a surgical procedure. Because the block is not an anesthetic, you could use an appropriate E/M code if the patient assessment and procedure are performed on different days. Check with your carrier about coding when the anesthesia provider performs the assessment and procedure on the same day. Some insurers include the E/M visit in the procedure cost, but others don't.Although an anesthesiologist usually administers Bier blocks, there are times when the surgeon performs the procedure. Opinions vary on which code is most appropriate in such a case. Two possibilities are surgical code 64450* (Injection, anesthetic agent; other peripheral [...]