Anesthesia Coding Alert

Question: The anesthesiologist performed a retrobulbar block before a patient's cataract surgery, and then administered monitored anesthesia care (MAC) during the procedure. How should I report the procedure and block (it's for a commercial carrier, not Medicare)? Should I also use modifier 59?


Alabama Subscriber
 

Answer: Start with the correct anesthesia code for the cataract surgery, which is 00142 (Anesthesia for procedures on eye; lens surgery).

Opinions vary on whether you can bill separately for the retrobulbar block. Many coders say no on the grounds that the physician administers the block for anesthesia during the procedure, not for postoperative pain relief. Because of this, you don't have a separate diagnosis to support reporting the block in addition to the procedure.

On the other hand, some coders say that payment for a retrobulbar block is usually bundled into the cataract code because the ophthalmologist usually administers the block. Coders in this camp believe you can bill the block separately in this case because the anesthesiologist administered it. Consequently, you can report 67500 (Retrobulbar injection; medication [separate procedure, does not include supply of medication]) and append modifier 59 (Distinct procedural service). 

Discuss the situation with your anesthesia team and the carrier involved. Once you have a better idea of the case details, you can determine whether billing separately for the block is appropriate.