Wiki Peripheral Nerve Block Codes-HELP

[leaandrea]

I am completing a new project on PNB. I normally do not work on these so this has been a learning process. I am wondering what codes you use for the following PNB? I am in Washington State if that matters for any guidelines. Any supporting links would be much appreciated as well. I know that is these are performed during the anesthesia time they cannot be charged separately. These would have separate reports and documented time outside anesthesia/OR time for post op pain.

IPACK-64450?

How do you code vastus medialis when performed during the PNB?- only documentation says it was performed.

Can you charge/code all theses together or only the genicular? genicular (all 3 areas documented) 64454+adductor 64447+IPACK 64450+vastus medialis?+76942

Usually I see just bilateral TAP block documented=64488 but if it says bilateral axillary TAP block is that64488 or 64417-50?

Thank you very much for your help!

 

[jkyles]

Hi there, start by reading chapter 2 of the National Correct Coding Initiative manual. It contains the typical rules for billing post-op pain management by an anesthesia provider. https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf. For example:

Per Medicare Global Surgery rules, the physician performing an operative
procedure is responsible for treating postoperative pain. Treatment of postoperative pain by the
operating physician is not separately reportable. However, the operating physician may request
that an anesthesia practitioner assist in the treatment of postoperative pain management if it is
medically reasonable and necessary. The actual or anticipated postoperative pain must be severe
enough to require treatment by techniques beyond the experience of the operating physician. For
example, the operating physician may request that the anesthesia practitioner administer an
epidural or peripheral nerve block to treat actual or anticipated postoperative pain. The epidural
or peripheral nerve block may be administered preoperatively, intraoperatively, or
postoperatively. An epidural or peripheral nerve block that provides intraoperative pain
management is included in the 0XXXX anesthesia code and is not separately reportable, even if
it also provides postoperative pain management. (See Chapter II, Section B, Subsection 4 for
guidelines regarding reporting anesthesia and postoperative pain management separately by an
anesthesia practitioner on the same date of service.

Coding:
IPACK is reported with the unlisted code according to CPT Assistant 6/2020.

The abductor block would be reported with 64447 and that would include the vastus medialis block (so report 64447 once).

However, 64447 is bundled into the genicular block and you'd need documentation that supports the use of a modifier to report both codes. Ultrasound needle guidance is also included in the genicular block. I also wonder if you're going to get challenged on the number of blocks for one patient

For the TAP block, I suggest asking the anesthesia provider or reviewing the documentation for the procedure. I see TAP blocks referred to as "Mid-axillary TAPs" but it isn't possible to say without the knowing what the provider did.

Hope this helps.

 

[leaandrea]

Hi there, start by reading chapter 2 of the National Correct Coding Initiative manual. It contains the typical rules for billing post-op pain management by an anesthesia provider. https://www.cms.gov/files/document/chapter2cptcodes00000-01999final11.pdf. For example:


Coding:
IPACK is reported with the unlisted code according to CPT Assistant 6/2020.

The abductor block would be reported with 64447 and that would include the vastus medialis block (so report 64447 once).

However, 64447 is bundled into the genicular block and you'd need documentation that supports the use of a modifier to report both codes. Ultrasound needle guidance is also included in the genicular block. I also wonder if you're going to get challenged on the number of blocks for one patient

For the TAP block, I suggest asking the anesthesia provider or reviewing the documentation for the procedure. I see TAP blocks referred to as "Mid-axillary TAPs" but it isn't possible to say without the knowing what the provider did.

Hope this helps.

Thank you for your help. By chance can you send me the link for the cpt asst please? Is this the latest in charging this? Is that how you are charging the IPACKS or do you charge for the IPACK?

For 64447 can you only charge that 1x per encounter?

And on the genicular, if they are stating the genicular and the adductor listed on the report, is that enough to bill both or need a separate report for both.
Ex: Block type: Adductor canal (saphenous), IPACK and geniculars (lists all 3). In another part of the report it states the medication injected into ea of these and what was used etc.

Thank you.

 

[jkyles]

Thank you for your help. By chance can you send me the link for the cpt asst please? Is this the latest in charging this? Is that how you are charging the IPACKS or do you charge for the IPACK?

For 64447 can you only charge that 1x per encounter?

And on the genicular, if they are stating the genicular and the adductor listed on the report, is that enough to bill both or need a separate report for both.
Ex: Block type: Adductor canal (saphenous), IPACK and geniculars (lists all 3). In another part of the report it states the medication injected into ea of these and what was used etc.

Thank you.

Hi, the CPT Assistant article is something I get through a subscription so a link won't work, but that's the latest guidance from CPT. You should check your payer policies to see if they state something different.

Yes, 64447 is 1x per patient/day

The documentation would have to show that the adductor block was distinct from the genicular and medically necessary. Review the full descriptor for modifier 59.