Anesthesia Coding Alert

Follow these 6 steps to handle procedure, block and aftercare coding The case: An anesthesiologist and CRNA worked together during a shoulder arthroscopy procedure. Determine how you would you code the following case, then read what our experts recommend. Procedure: Arthroscopy of the patient's left shoulder

Staff present: Anesthesiologist and CRNA

Anesthesia service: The team provided general anesthesia during the procedure. At the end of the procedure the anesthesiologist inserted a pain pump, which the patient had for two days following surgery. As the patient woke from general anesthesia, the anesthesiologist administered an interscalene nerve block. Step 1: Code the Procedure's Anesthesia Your first step in reporting the procedure is simple, says Kim Arnett, CPC, coder for Georgia Anesthesiologists PC, in Marietta, Ga. Submit 01630 (Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified) for general anesthesia during the arthroscopy procedure.
 
Other coders agree with this approach. "01630 is the correct code for the arthroscopy unless the physician performed it for diagnostic purposes only or the service was not for a specific procedure listed," says Donna Howe, CPC, with Anesthesiology Associates of Eastern Connecticut PC, in Manchester. Step 2: Code the Pump's Catheter Placement The anesthesiologist placed a pain pump, which means there must be some way for the pain medication to be delivered. This is the same as a continuous interscalene block being administered via catheter attached to a pump.

Report the catheter placement with 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration). Because the anesthesiologist placed the pain-relief catheter on the same day as the surgical procedure, you append modifier -59 (Distinct procedural service) to procedure code 64416. Step 3: Code the Interscalene Block Coders disagree on whether it is appropriate to report the interscalene block that the anesthesiologist administered as the patient awoke. The key here is having documentation of the block's medical necessity, considering that the anesthesiologist had already placed the pain pump and catheter.

Documentation of medical necessity would be a written order or request from the surgeon asking that the anesthesiologist administer the block, Arnett says. The anesthesiologist can also use documentation of the surgeon's oral request for the service to support the block's medical necessity.

If you have clear documentation to support using the block, report 64415 (... brachial plexus, single). Again, append modifier -59 because the anesthesiologist performed the injection on the same day as surgery. Include the primary diagnosis code of V58.49 (Other specified aftercare following surgery).

"I can only think of one scenario where you might be able to bill and get reimbursed for both services (64415 and 64416)," Howe [...]