Anesthesia Coding Alert

Question: How should I code a femoral nerve block followed by spinal anesthesia during arthroscopic-assisted surgery to repair a torn anterior cruciate ligament?

Missouri Subscriber  Answer: If the femoral nerve block was given for postoperative pain relief (even if it was administered before the actual surgical procedure), code it as 64447 (Injection, anesthetic agent; femoral nerve, single) with modifier -59 (Distinct procedural service). Report the pain block in addition to the spinal anesthesia for the surgical case (get a written request for the post-op block from the surgeon if possible to help distinguish it from anesthesia during the procedure). Use V58.49 (Other specified aftercare following surgery) as the diagnosis supporting the femoral block's necessity. And use 64448 (... femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) if the physician uses a catheter. 64448 has a 10-day global period, so the catheter's daily management is included in reimbursement for its placement.