Anesthesia Coding Alert

Question: Several of our physicians refer to IVRA for various surgeries, particularly trigger point repair. One physician documented MAC (monitored anesthesia care) for a case, but did not include the MAC compliance statement. When we questioned the chart, he said he used a Bier block for the mode of anesthesia instead of MAC. Can a time-based regional not be MAC?

Rhode Island Subscriber
  
Answer: Regional and MAC anesthesia are different types of anesthesia, which means your providers should clearly indicate which type they provide.
 
IVRA is intravenous regional anesthesia, commonly referred to as a Bier block. Physicians use Bier blocks for short procedures on the extremities (usually the wrist or hand) as a pain management or therapeutic procedure but can also use a Bier block as anesthesia during a procedure.
 
Bier blocks and MAC are not the same thing. Because of this, verify whether the physician used MAC or a Bier block. If he used MAC, report 01810 (Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of forearm, wrist and hand) and append modifier QS (Monitored anesthesia care service) if your carrier requires MAC modifiers.

If your physician used a Bier block as the primary anesthesia, don't get tricked by 01995 (Regional intravenous administration of local anesthetic agent or other medication [upper or lower extremity]). Report 01995 when the Bier block is the actual pain-relieving procedure. When your anesthesiologist administers a Bier block as anesthesia during another procedure, bill as with spinal or general anesthesia: with the anesthesia code that crosses from the surgical procedure.