ED Coding and Reimbursement Alert

Question: Our physician sutured a patient's finger and administered a digital block for pain relief. Can I assign 64450 in addition to the suture repair code?

Kentucky Subscriber  
Answer: If the only procedure performed was the digital block, 64450 (injection, anesthetic agent; other peripheral nerve or branch) would be reported. You indicate, however, that a suture repair was completed. Digital blocks are not reported separately from a surgical procedure such as laceration repair to the finger. When anesthesia is provided for a surgical procedure, CPT guidelines state that "local infiltration, metacarpal/digital block, or topical anesthesia " is included.
 
Coding digital blocks in combination with starred procedures for non-Medicare patients can be tricky. The CPT manual under the starred procedure note states, "usual package concept for surgical procedures cannot be applied." Request from the payer in question a written copy of its policy on digital blocks.  
Reader Questions and You Be the Coder were reviewed by John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth Inc. in Knoxville, Tenn.; and Tracie Christian, CPC, CCS-P, director of coding for ProCode in Dallas.