Check Provider's Role Prior to Coding Retrobulbar Blocks

The anesthesiologist's involvement guides you in the right direction.



Coding your anesthesia provider's service is never easy, more so with intricate procedures such as retrobulbar block placement. Here are three questions and answers regarding your anesthesiologist's involvement in the case to know how to properly code her services every time.



Does the anesthesiologist handle everything?



Since administering anesthesia for retrobulbar blocks is riskier than other ocular injections, some surgeons (or facilities) prefer to have the anesthesia team handle everything. If your anesthesiologist is involved throughout the case, she administers the initial block and then administers monitored anesthesia care (MAC) during the case.



Report it: Your anesthesiologist places the block in preparation for the procedure, and not as a separate pain management service. As a result, you only code for the eye procedure in place of the procedure and block. Select the proper code from 00140-00148 (Anesthesia for procedures on eye …). Depending on carrier requirements, add modifier QS (Monitored anesthesia care service) to indicate MAC.



In this scenario, anticipate your anesthesiologist to report discontinuous time. She'll place the block, leave the room while the block takes effect, and return in time for the procedure. Since she won't be with the patient from start to finish, keep a tab on your time units. Estimate the time she spends placing the block and with the patient during the procedure for the total minutes.



Note of caution: Patients requiring retrobulbar blocks are often scheduled back to back. This can make tracking your anesthesia provider's time tricky. Just be careful to ensure that case times do not overlap when calculating the number of cases your anesthesiologist medically directs or supervises. Some practices decide to stay away from potential compliance risks by not trying to capture the discontinuous time.



Does the anesthesiologist monitor only?



Some facilities and many payers favor that the surgeon place the initial block and the anesthesia professional monitor the case.



Report it: As the anesthesiologist works in a supervisory capacity, include the proper medical direction modifiers for the anesthesiologist and/or CRNA as required.



Check your guidelines



When cases covering retrobulbar blocks cross your desk, check the payer's stance prior to automatically coding your anesthesiologist's service, even if she placed the initial block. Some payers bundle the retrobulbar block into the ocular surgery payment while others consider the block to be the local anesthesia and bundle it with the anesthesia code. Knowing payer guidelines will aid the anesthesiologist and surgeon find out the best approach to the case.



What's more, check the payer's diagnosis guidelines too. Common diagnoses leading to eye surgery and most likely retrobulbar blocks -- include cataracts (366.xx), glaucoma (365.xx), strabismus (378.xx) and retinal detachment (361.xx).



For more on this and for other specialty-specific articles to assist your anesthesia coding, sign up for a good medical coding resource like Coding Institute.