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Adductor Canal Block and Femoral Nerve Block

The patient had an ACL Repair.

Our Anesthesiologist provided General Anesthesia for the procedure but also performed an Femoral Nerve Block and an Adductor Canal Block for Postoperative Pain.

I feel that both of these blocks are billed with 64447 but there is a MUE of 1 per day on this code.

His note says the Left Groin was prepped and draped and using ultrasound guidance the femoral and sciatic nerves were visualized. A non stimulating needle was used and after negative aspiration 20ml of .5% Ropivacaine was inject4ed in 5ml increments. The lower leg was then prepped and drapped in sterile fashion 20ml of local was used. The saphenous branch was blocked 8cm above the knee in the medial aspect of the thigh using 5cc of .5% Ropivacaine.

I have 2 questions:
1. Does the above note justify both a femoral and adductor canal block?
2. How do you properly bill for both an Adductor Canal Block and Femoral Block?

01400-S83.512A
64447-59-G89.18/M25.562
64447-59-G89.18/M25.562 or should 64447-59 be on one line with 2 units
76942-26

I would appreciate hearing if anyone bills for Femoral and Adductor Blocks together.
Thank you,
Julie

Medical Billing and Coding Forum

Ear canal lesion debridement

I’m looking for advice on the following procedure:
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History from: patient
Reason for visit: F/U procedure – e/o R ear canal lesion

Pt is here today for excison of right ear canal vascular lesion; has been there for several years and waxes and wanes in size; nontender but almost completely occludes the ear canal.

Right Ear
External: Pinna and periauricular area is normal.
Canal: bluish vascular lesion posterior lateral canal, almost completely occluding, able to debride cerumen and visualize intact TM
Tympanic Membrane: Tympanic membrane intact and mobile, no middle ear effusion or masses appreciated.
microscope used to examine ear

Consented for incision/debridement of right ear canal lesion.

[Procedure]
Cleansed with betadine, injected with 0.2 cc 1% xylo with 1:100kepi locally. 22 gauge needl aspirated –scant ; bacitracin ointment placed medially, then superficial skin debrided with cup forceps and cauterized with bipolar forceps and ear canal packed with Mycolog cream, cotton ball placed in meatal opening. Tolerated well.
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The physician is suggesting 69145 for removal of an ear canal lesion and 92504 for use of the microscope, but the notes indicate just a debridement. Since there is no specific code for debridement of the external ear, I have read that it may be best to code just the 92504 or code 69399 for an unlisted procedure and include notes w/ a code that has comparable work values.

However, the mention of cauterization leads me to think perhaps a destruction code is warranted (17004? 17110 due to mention of a vascular lesion?) Any help would be appreciated. Thanks in advance.

Medical Billing and Coding Forum