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Knowing when you are required to use modifier 59 is key to 64416 payment. Brachial plexus block sounds like a challenge, and many coders wrestle with whether to involve the post-operative continuous catheter with their anesthesiologists global period billing in order to get proper reimbursement. In case you assume that every single post-operative brachial plexus continuous catheter placement your anesthesiologist carries out is bundled into the surgical procedure, you could be costing your practice around $82 per patient. Knowing when you can -- and can’t -- report CPT code 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) is as easy as following these three expert tips. Tip 1: Use 64416 for Post-Op Pain After shoulder surgery, patients frequently need pain management. When the surgeon asks your anesthesiologist to give a brachial plexus catheter, you may be lured to skip reporting 64416 supposing the post-operative pain service is included in the surgical coding. Frequently, however, you can justifiably report CPT code 64416 and seek payment. After your anesthesiologist places a continuous catheter to administer the brachial plexus block, you must separately report 64416. Here’s why: The Correct Coding Initiative’s (CCI’s) guidance on routine postoperative pain management services specifies that it is included in the global surgical fee and must not be reported by the anesthesiologist except separate, medically necessary services are needed that cannot be rendered by the surgeon. An axillary block, which a surgeon does not have the expertise or training to do, would be a distinct reimbursable service. Any kind of shoulder repair surgery -- rotator cuff, partial rotator cuff, total replacement -- is one of the more general uses of nerve blocks for post operative pain Tip 2: Involve Modifier 59 For a lot of payers, you should append modifier 59 (Distinct procedural service) to CPT code 64416 unless specific payer policy prohibits use of the 59 modifier with a single line item claim. Reason: This tells the insurance payer that the anesthesiologist did not use the injection or block as the means for anesthesia but was a distinct procedure. Money matters: In case you avoid reporting 64416 altogether, you could be costing your practice $82 per injection Tip 3: Get Anesthesia Request in Writing You can only report CPT code 64416 separately in case you have documentation from the anesthesiologist which supports the separate nature of the catheter. Pointer: A way to complete this is to have an area on the anesthesia record for documenting these items, for instance separate boxes for the digital start and stop times of the injection or block. Certain payers may need this information to prove that the minutes were not involved in the anesthesia time.
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