Anesthesia Coding Alert

Steer Clear of Separate Block Time Coding

Question: Can our physician bill for the time he spends administering a block in the day surgery unit, prior to room entry time for the OR? We bill the appropriate anesthesia code for the surgery and then bill the block with modifier 59, but now he wants to bill the block time.


Ohio Subscriber

Answer: Administering a block is a flat-fee surgical service, which means you don't report the time associated with it. You can report a code such as 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]) and append modifier 59 (Distinct procedural service) to indicate that the epidural is separate from the surgical procedure--and that your physician didn't use the line to administer anesthesia. Just don't include a charge for time.

Where to find info: Check the ASA's Relative Value Guide for more information. In the codes listed for blocks, the book includes a base value but does not include the "TM" notation indicating that you can also bill for the procedure's time.

Carrier source: Also check your local carrier policies for details. For example, an Aetna policy includes the statement, "Time spent by an anesthesiologist administering a nerve block (i.e., injecting an anesthetic agent into or around a given nerve) is included in the total anesthesia time. Therefore, it is not eligible for separate payment."

To read more about this policy, log on to ASA's Web site at www.asahq.org/Washington/aetnapolicies.pdf.