Anesthesia Coding Alert

Try these surefire coding strategies Think you're coding brachial plexus blocks correctly?  Read on to learn if you're coding correctly and up-to-date on potential new techniques for BP blocks. Understand Why Docs Use BP Blocks Anesthesiologists often administer brachial plexus blocks for one of three reasons: to help ease post-surgical pain, for pain management purposes, or for surgical anesthesia.
 
Postsurgical injections block nerves for a few hours after surgery so the patient doesn't wake up in pain from an upper-extremity or shoulder surgery. These blocks work best for minimally invasive procedures like arthroscopic or simple open repairs, says Robin Fuqua, CPIC, anesthesia coder for Jose Veliz, MD, in Escondido, Calif. More complicated procedures such as total shoulder replacement usually require multi-day analgesics, which can include PCA (patient-controlled analgesia) management over several days instead of a single injection.
 
Chronic pain management injections block nerves from communicating pain in the area when there seems to be no physiologic reason for continuing pain (usually after a traumatic injury was treated and should be healed). "Sometimes, just making the nerves stop sending pain signals for a while 'resets' them so after the drug wears off, they send less severe or no signals of pain," Fuqua says. Look at Administration Technique First The brachial plexus is part of the last four cervical and first thoracic vertebrae, and it branches off to the main nerves of the shoulders, chest and arms.
 
Anesthesiologists typically report CPT 64415* (Injection, anesthetic agent; brachial plexus, single) or 64416 (... brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) for brachial plexus blocks with anesthetic agents. Determine whether the physician placed a catheter or performed a single injection for postoperative pain and administered general anesthesia, or whether the physician provided anesthesia with the brachial plexus block.
 
Now you can report continuous infusion blocks more accurately, thanks to the addition of 64416 in CPT Codes 2003. Prior to this, some physicians reported 64415 for each day, but this was misleading since it implied that the physician administered a new block daily. Other physicians reported a subsequent hospital visit code or other E/M code reflecting the level of service.
 
Report injections of neurolytic agents with 64613 (Chemodenervation of muscle[s]; cervical spinal muscle[s] [e.g., for spasmodic torticollis]) or 64640 (Destruction by neurolytic agent; other peripheral nerve or branch). Physicians are especially careful about administering neurolytic agents because they permanently damage the nerve, so you should be just as careful about reporting the most accurate code.
 
Code 64416 has a 10-day global period, which means you don't code [...]