Anesthesia Coding Alert

Question: Ive never been clear on whether you can bill for a nerve block for cataract surgery (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 doctor suggests 64450* (injection, anesthetic agent; other peripheral nerve or branch). Does this require a modifier and a different ICD-9?

Arizona Subscriber

Answer: The nerve block cannot be billed if it is the method of monitored anesthesia care (MAC) for the cataract surgery. Nerve blocks can be billed only for pain management and are not part of the surgery anesthesia delivery system. Further, if the block is placed and the patient is held for some time in the pre-anesthesia area before being taken to the operating room, you can bill split time for the block and for the surgery. If the case is Medicare, be sure to include the MAC modifier -QS (monitored anesthesia care service). If you are doing nerve blocks for pain management, be sure the first ICD-9 code is for pain like 379.91 (ophthalmic pain). The rest of the ICD-9s can describe the patients surgical problem.