Anesthesia Coding Alert

Choose carefully between surgical and anesthesia code options.

Retrobulbar block placement is an intricate procedure, which is why surgeons often rely on an anesthesiologist’s expertise instead of placing the block themselves. Keep three tips in mind to know how to correctly code your provider’s service every time.

Tip 1: Pick a Single Code for the Service

How you report the service will depend on whether the anesthesiologist only places the retrobulbar block or places the block and monitors the patient during the procedure.

Option 1: If your provider only administers the block, she is providing a surgical service. Report the block placement with 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]).

Option 2: If your anesthesiologist administers the block and provides anesthesia during surgery, you should submit an anesthesia code. Choose the appropriate code from 00140-00148 (Anesthesia for procedures on eye ...). The most common codes for a retrobulbar block are 00142 (Anesthesia for procedures on eye; lens surgery) when used for cataract surgery (which carries four base units) or 00140 (Anesthesia for procedures on eye; not otherwise specified) for many other procedures (which carries five base units).

When reporting the anesthesia code, you might need to append modifiers to indicate MAC, says Kelly Dennis, MBA, ACS-AN, CANPC, CHCA, CPC, CPC-I, owner of Perfect Office Solutions in Leesburg, Fla. These include modifier QS (Monitored anesthesia care service), G8 (Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure), or G9 (Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition).

Tip 2: Watch the Time Units

If you’re reporting an anesthesia code, include time units in your fee calculation, based on the time associated with the block placement and procedure.

Expect your anesthesiologist to report discontinuous time in this scenario. She will place the block, leave the room while the block takes effect, and return in time for the procedure. Because she won’t be with the patient from start to finish, watch your time units. Calculate the time she spends placing the block and with the patient during the procedure for the total minutes.

Caution: Patients needing retrobulbar blocks often are scheduled back-to-back, which can make tracking your anesthesia provider’s time tricky. Be careful to ensure that case times don’t overlap when calculating the number of cases your anesthesiologist medically directs or supervises. Some practices decide to avoid potential compliance risks by not trying to capture the discontinuous time.

Tip 3: Check Payer Guidelines

When cases involving retrobulbar blocks cross your desk, check the payer’s stance before automatically coding your anesthesiologist’s service — even if she placed the initial block. Some payers bundle the retrobulbar block into the ocular surgery payment; others consider the block to be local anesthesia and bundle it with the anesthesia code. Knowing payer guidelines will help the anesthesiologist and surgeon determine the best approach to the case.

Also check the payer’s diagnosis guidelines. Common diagnoses leading to eye surgery — and possibly retrobulbar blocks — include cataracts (H25.-, Age-related cataract or H26.-, Other cataract), glaucoma (H40.-), strabismus (H50.-, Strabismus (congenital) (nonparalytic)), and retinal detachment (H33, Retinal detachments and breaks).