Anesthesia Coding Alert

Coding for somatic nerve injections will get even easier when CPT Codes 2003 goes into effect next month, thanks to several new and revised codes with more specific descriptors.

CPT has added four new somatic nerve injection codes and has revised two existing codes to coincide with the additions.

The CPT changes define whether the service is for a single injection or for a catheter insertion for continuous administration and daily management of an anesthetic. "Being able to differentiate between single and continuous administration will be advantageous for many providers," say coders such as Beverly M. Gillespie, CPC, billing and collection manager with PSG Billing and Collection in Milwaukee. Cut Down on Using Unlisted-Procedure Codes Some of the wording changes in the new and revised codes are so minor that you could easily miss them. But paying attention to the details will help you code correctly and will virtually eliminate use of the unlisted-procedure code for these injections. Keep an eye out for these changes:

  64415* Injection, anesthetic agent; brachial plexus, single. This code (as well as several others in the injection group) has been revised to represent single injections. 64416* brachial plexus, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. This new code balances the 64415 revision. You should use a continuous brachial plexus block for cases such as treating reflex sympathetic dystrophy (RSD) of the upper extremity or during extensive upper-extremity surgery. You will use all of the codes in this group that specify "continuous infusion" in an inpatient setting rather than as an outpatient service or treatment in the physician's office. 64445* ... sciatic nerve, single. Again, the designation of "single" is new. 64446* sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration. This is another new code. Femoral and/or sciatic nerve blocks are becoming more common in joint replacement surgery (particularly the knee), says Albany, N.Y., anesthesiologist Scott Groudine, MD. "Many practices are switching from managing postoperative pain in these patients from an epidural to a continuous nerve block technique," he says. 64447* ... femoral nerve, single. This is another new code that distinguishes the treatment as a single injection. 64448* femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. Groudine expects coders to use this new code for knee surgery or similar cases.

Many coders and pain management specialists are pleased to have specific codes for single injections rather than continuous infusion. They expect to make particularly good use of new codes 64445 and 64447.

For example, [...]