nctxil

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How do you bill for an ankle block for post-op pain?

Thanks
 
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nctxil

Anesthesiology
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Jan 16, 2007
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It falls under CPT code 64450 (other peripheral n. branch).
Somebody tried to tell me that you could bill femoral and sciatic.

Just 64450-59 x1? Not for multiple nerves, right?
 

scoobydum

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It depends, I guess, on the exact site of blockade. I think if you're doing a proper ankle block (getting the 5 terminal branches), then you may be able to try to bill for all five, but what you'll actually be reimbursed is a different story. To bill (and collect) for fem and sciatic, though, you'd probably have to do fem and sciatic blocks proper.

When i do blocks for postop analgesia for ankle cases, I usually do a sciatic (either midthigh or at the popliteal fossa) and saphenous block (at the tibial plateau). The -59 modifier comes into play if you do them under Ultrasound and have documented the imaging. Hope this helps.
 
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nctxil

Anesthesiology
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Jan 16, 2007
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It depends, I guess, on the exact site of blockade. I think if you're doing a proper ankle block (getting the 5 terminal branches), then you may be able to try to bill for all five, but what you'll actually be reimbursed is a different story. To bill (and collect) for fem and sciatic, though, you'd probably have to do fem and sciatic blocks proper.

When i do blocks for postop analgesia for ankle cases, I usually do a sciatic (either midthigh or at the popliteal fossa) and saphenous block (at the tibial plateau). The -59 modifier comes into play if you do them under Ultrasound and have documented the imaging. Hope this helps.

So, you can bill for multiple nerves for an ankle block? 64450-59 x 5 I didn't think that was correct. Do payers actually pay for that?

I thought the -59 modifier was for a block that is distinct from the anesthetic (for post-op pain)
 

scoobydum

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I think at best you can reasonably expect to get one global fee for an ankle block using the 64450 code (i.e., 64450x1, not x5). In order to avoid all of the potential headache, that's why i usually stick to sciatic and saphenous n. blocks to cover the ankle and not have issues regarding reimbursement. There is no specific "ankle block" per se with an assigned code (at least in the 2010 RVG put out by the ASA).

You might be right about the -59 modifier: when i spoke to our billing folks a couple years ago, -59 usually came up in relationship to ultrasound-guided blocks, but your interpretation makes sense.

So, you can bill for multiple nerves for an ankle block? 64450-59 x 5 I didn't think that was correct. Do payers actually pay for that?

I thought the -59 modifier was for a block that is distinct from the anesthetic (for post-op pain)