Anesthesia Coding Alert

Question: What code should be used for a Bier block on a patient who presented with ankle/foot pain?

Pennsylvania Subscriber

Answer: The best code for this situation depends on the purpose of the block. If it is used as an anesthetic for a surgical procedure, you should bill the appropriate CPT code for the anesthetic (e.g., anesthesia for procedure on the foot, 01462-01522 [anesthesia codes for procedures on the lower leg]). If the carrier requires you to do so, bill the anesthetic using the appropriate surgical CPT code (e.g., codes 27600-28825 [procedures on the leg and ankle joint], depending on the surgery performed).

If the Bier block is used for a diagnostic or therapeutic treatment, you would bill it under that particular diagnostic or therapeutic procedure (such as 01995, regional IV administration of local anesthetic agent or other medication [upper or lower extremity]), and it would not be considered an anesthetic. For pain management, use unlisted procedure code 64999 (unlisted procedure, nervous system).

Administering a Bier block is time-consuming and requires the use of a special tourniquet. The physician should provide very specific details in the procedural report explaining the reason for the service.

Even with proper documentation, payment for Bier blocks can be inconsistent. You may wish to check with your local carrier to see what coding it prefers and what type of reimbursement you can expect in return.