Anesthesia Coding Alert

Retrobulbar blocks (67500*), which surgeons sometimes request anesthesiologists to administer because theyre riskier than other ocular injections, are pretty
tricky to code particularly for Medicare and third-party carrier reimbursement.

Billing 67500* Versus Anesthesia Codes

Code CPT 67500* appears in the Eye and Ocular Surgery section of the CPT as a stand-alone procedure. I have always followed the rule of thumb that if a block or injection is the anesthesia for a surgical procedure, use the appropriate anesthesia CPT codes to report it. However, if it is a stand-alone injection or procedure, use the appropriate pain-management, nerve block or injection code instead, says Theresa Ruiz-Law, director of managed care and reimbursement for the American Association of Nurse Anesthetists in Park Ridge, Ill.

Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Anesthesiology Medical Group Inc. of Loma Linda, Calif., says 67500* is used, for example, when an injection block is given to a patient with multiple facial lacerations for pain control. Its also used for unusual complications (such as a sudden increase inblood pressure) that preclude continuing surgery. If the surgery is discontinued after the administration of the retrobulbar block, code the procedure with 67500* to indicate that the injection was for pain management with no further monitoring.

In surgical situations, either the surgeon or the anesthesiologist might administer the nerve block. Often, however, the anesthesiologist is still likely to provide patient monitoring as well as additional medication to help calm the patient. Therefore, the anesthesiologist should bill the service with anesthesia codes that accurately reflect the level of care, Johnson says.

In this instance, you can bill nerve blocks only for pain management. Ruiz-Law cautions that some managed care companies will lump retrobulbar blocks into the ocular surgery payment. Other carriers consider the blocks local anesthesia and bundle it with the anesthesia code. (If the payment for a block is bundled into the surgical code, it is up to the surgeon and anesthesiologist to negotiate fees.)

Yet, in the case of eye surgeries most commonly associated with retrobulbar blocks, such as 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]), the anesthesiologists role extends far beyond administering the block. Mary Klein, coding specialist with Panhandle Medical Services of Pensacola, Fla., notes that anesthesiologists seldom administer only a retrobulbar block. In our practice, we use the pertinent anesthesia code, such as 00142 (anesthesia for procedures on eye; lens surgery), because it includes patient sedation during surgery and the level of monitoring necessary before, [...]