Chart Talk: Anesthesia Coding Conversations

Brachial Plexus – CPT 64415/64416

A brachial plexus nerve block is a regional anesthesia technique where local anesthetic is injected near the brachial plexus (a network of nerves for the arm) in the neck, above the collarbone, or armpit to numb the entire arm for surgery or to manage chronic pain, often as alternative to general.  When brachial plexus is used for acute post op pain management 

How does it work and its purpose?

• Blocks Pain:  Temporarily stops pain and movement in the arm by numbing the nerve bundle.
• Surgical Anesthesia:  Allows for awake or sedated surgery on the arm shoulder, or hand, avoiding general anesthesia side effects.
• Pain Management:  Provides relief for arm and shoulder pain.

Common Approaches:

• Interscalene:  Near the neck (between scalene muscles), best for shoulder surgery.
• Supraclavicular:  Above the collarbone, excellent for elbow, wrist, and hand surgery.
• Infraclavicular:  Below the collarbone
• Axillary:  In the armpit, for hand, wrist, and forearm procedures.  

Procedure & Guidance:

A doctor uses landmarks and often ultrasound to guide a needle to inject anesthetic near the nerves, sometimes placing a catheter for continuous pain relief.  Ultrasound is bundled with code 64415/64416.

Ancillary Nerve Block – CPT 64417

An ancillary nerve block is used for post op pain control, often for surgeries in the forearm, hand, wrist, or shoulder.  It is billed for a single injection, providing pain relief by temporarily interrupting nerve signals, and requires specific documentation showing it’s separate from the main surgical anesthetic for. Post-op pain management.

How it Works for Post-Op Pain:

• The axillary nerve block targets the axillary nerve, a key nerve from the brachial plexus, located near the armpit.
• Anesthetic is injected near the nerve, often within a fascial compartment, to numb the area and block pain signals.
• It’s a common component of multimodal pain strategies to reduce reliance on opioids.

Common Usage Examples:

• Pain control after wrist fractures, elbow surgeries or shoulder surgeries.
• Part of a comprehensive approach (along with other blocks like the suprascapular nerve block) for shoulder analgesia.

* Axillary approach to Brachial Plexus is coded as 64415 (typically shoulder cases).  True Axillary Blocks target the Axillary nerve and are coded 64417 (typically forearm/wrist/hand procedures).  Review the block note to confirm the targeted nerve

Suprascapular Nerve Block – CPT 64418

A suprascapular nerve block (SSNB) is a highly effective technique for managing acute postoperative shoulder pain, especially after arthroscopic procedures, by injecting local anesthetic around the nerve that supplies about 70% of the shoulder’s sensation, significantly reducing opioid needs, nausea, and pain scores, and allowing for earlier rehabilitation. It’s a safe alternative for patients with lung issues who can’t have general nerve blocks and can be combined with other blocks (like axillary) for even better results, though it’s less effective than a full interscalene block but offers better safety. 

How It Works:

• Injection: A doctor injects a local anesthetic (like lidocaine/bupivacaine) near the suprascapular nerve, often guided by ultrasound for precision.
• Pain Interruption: The anesthetic temporarily blocks pain signals from the shoulder joint to the brain.
• Safer Alternative: Avoids phrenic nerve block (diaphragm paralysis) seen with interscalene blocks, making it ideal for patients with lung disease, notes ASRA Pain Medicine.

When It’s Used:

• Arthroscopic shoulder surgeries (rotator cuff repair, etc.).
• Chronic shoulder pain (arthritis, frozen shoulder, tendonitis). 

Techniques:

• Posterior Approach: Common, targeting the nerve at the suprascapular notch.
• Anterior Approach: Also described and effective.
• Combination: Often paired with an axillary nerve block (SSNB+ANB) for comprehensive pain relief, though it may not surpass a standard interscalene block (ISB) but offers fewer side effects like breathing issues. 

Suprascapular Nerve Block – CPT 64418

A suprascapular nerve block (SSNB) is a highly effective technique for managing acute postoperative shoulder pain, especially after arthroscopic procedures, by injecting local anesthetic around the nerve that supplies about 70% of the shoulder’s sensation, significantly reducing opioid needs, nausea, and pain scores, and allowing for earlier rehabilitation. It’s a safe alternative for patients with lung issues who can’t have general nerve blocks and can be combined with other blocks (like axillary) for even better results, though it’s less effective than a full interscalene block but offers better safety. 

How It Works:

• Injection: A doctor injects a local anesthetic (like lidocaine/bupivacaine) near the suprascapular nerve, often guided by ultrasound for precision.
• Pain Interruption: The anesthetic temporarily blocks pain signals from the shoulder joint to the brain.
• Safer Alternative: Avoids phrenic nerve block (diaphragm paralysis) seen with interscalene blocks, making it ideal for patients with lung disease, notes ASRA Pain Medicine.

When It’s Used:

• Arthroscopic shoulder surgeries (rotator cuff repair, etc.).
• Chronic shoulder pain (arthritis, frozen shoulder, tendonitis). 

Techniques:

• Posterior Approach: Common, targeting the nerve at the suprascapular notch.
• Anterior Approach: Also described and effective.
• Combination: Often paired with an axillary nerve block (SSNB+ANB) for comprehensive pain relief, though it may not surpass a standard interscalene block (ISB) but offers fewer side effects like breathing issues. 

I’ve been asking myself a question lately—one that I think many educators, writers, and content creators ask at some point:

Is this really helping anyone?

I spend hours researching, writing, creating tip sheets, and sharing knowledge through this blog. Yet sometimes… it feels quiet.
No comments.
Little interaction.
No visible feedback.

And in those moments, it’s easy to wonder:
Is this beneficial? Should I continue spending my time doing this if no one is interacting?

Here’s what I’ve come to realize.

Quiet Does Not Mean Useless

Not everyone who benefits from something speaks up. Many people read quietly. They save posts. They bookmark resources. They revisit information when they need it most. Especially in healthcare and coding, people are often overwhelmed, busy, or unsure of what to say—but that doesn’t mean the information isn’t valuable.

I remind myself that education isn’t always loud. Sometimes its impact is silent.

Not Every Seed Sprouts Immediately

This blog wasn’t created for instant gratification. It was created to educate, support, and guide—especially those navigating anesthesia coding, compliance, and documentation who may feel unsure or alone.

Some seeds take time. Some won’t sprout until months—or even years—later. And some may help someone in a way I’ll never see or hear about.

That doesn’t make the effort wasted.

Why I Started This in the First Place

I didn’t start this blog for likes or comments. I started it because:

• I’ve spent decades in this field
• I’ve made mistakes and learned from them
• I know how confusing anesthesia coding can be
• And I wanted to create a place that made it just a little easier for someone else

That purpose hasn’t changed—even on the quiet days.

So… Should I Continue?

That’s the question, isn’t it?

And my answer—at least for now—is yes.

Because if even one person finds clarity, confidence, or reassurance from something I’ve shared, then it is helping someone. Even if I never know their name. Even if they never comment.

Sometimes impact isn’t measured by interaction. Sometimes it’s measured by consistency, intention, and heart.

If you’re reading this and you’ve ever questioned whether your efforts matter—this is your reminder:
They do.

And maybe that’s reason enough to keep going.

Post-operative pain blocks continue to be an area of confusion for many coders, auditors, and providers—particularly when it comes to what is separately reportable, which CPT codes apply, and what documentation is truly required to support billing. This multi-part series is designed to break post-op pain block coding down into clear, practical segments, beginning with a foundational overview of the applicable CPT codes and the documentation elements that must be present to support compliant billing. Each installment will build on the last, addressing common scenarios, compliance pitfalls, and audit-focused considerations to help ensure post-operative pain management services are coded accurately, defensibly, and consistently.

What is required in the documentation in order for the post op block to be billable?

1. Who placed the block? We as coders and auditors cannot assume that the attending Anesthesiologist/CRNA for the anesthesia sedation service also performed the block. The block note documentation must clearly identify the specific provider or who placed the block.  
2. Who requested the block? The documentation for the block should clearly indicate that it was placed at the surgeon’s request. Phrases such as “per surgeon’s request” or “for post-operative pain management, at the request of the surgeon” are commonly used and help establish this. This language is important to support medical necessity in the event of payer questions or audits. Ultimately, the surgeon is responsible for post-operative pain management and must delegate that responsibility when appropriate. 
3. What type of block? Coders and auditors should identify the block type by looking for the specific name of the block performed — for example, interscalene, adductor canal, femoral, intercostal, etc. 
4. What delivery method was used to administer the post-operative pain procedure? The documentation must clearly indicate whether it was a single-shot injection or a continuous catheter technique. CPT selection should be based on the documented method of delivery. 
5. Where was the block placed? Accurate code selection depends on the anatomical location documented in the documentation Specifically, the documentation should clearly identify the nerve or region that was injected, infused, or blocked. For example, a block labeled as “Saphenous” may be reported using CPT 64447 (Femoral nerve block) if performed in the mid-thigh region (Adductor Canal), or CPT 64450 (Other peripheral nerve or branch) if performed below the knee. Additionally, the documentation must specify laterality—whether the block was performed on the left, right, or both sides—to ensure correct coding. 
6. Why was the block placed? Anesthesiologists must clearly document the indication for the block. When a block is performed specifically for post-operative pain and is separately billable as a fee for service, it requires distinct documentation that supports its medical necessity as a separate service. If the documentation is unclear or leaves room for interpretation regarding whether the block was part of the primary anesthetic, coders should query the clinician for clarification to ensure accurate coding and compliance. 
7. When was the block placed? The AMA (American Medical Association) has clarified that anesthesia time can be billed for the period spent placing a block, provided the block placement occurs after induction of the primary anesthetic but before emergence. If the block is placed after anesthesia start time but before induction, discontinuous anesthesia time should be applied, meaning the time spent performing the block is excluded from the total billable anesthesia time. To accurately determine if block time is billable or if discontinuous time must be applied, coder should review the following key documentation elements:   Start time of the block injection/placement of catheter   * Stop time of the block injection/catheter   Induction time (primary anesthetic)  
8. Was the block performed under ultrasound guidance? In 2025, most block codes now include ultrasound guidance, but there are some (64450) that still don’t so it is important to know what type of verbiage we need in order to bill 76942. Ultrasound guidance may be separately billable when it is not included in the description of the nerve block and is adequately supported by documentation. To meet medical necessity requirements, the ultrasound image must be retained in the patient’s permanent medical record and clearly identify the patient and date of service.  The documentation should include language similar to the following examples:  Ultrasound guidance used to guide the needle for satisfactory placement (e.g. “Under US, needle guided and appropriately placed.” “Ultrasound guidance used for needle placement”). Ultrasound guidance used to view medication diffusion (e.g., “US used to visualize spread of anesthetic,” “Medication spread viewed under U/S”). 

Below is a quick overview of different blocks and there CPT Codes. In the Post-Op Block Series, I will be covering different blocks each week.

You know you’re capable.
You know you can do it.

And yet… you hesitate.

Not because you lack the skills.
Not because you haven’t put in the work.
Not because you’re unprepared.

So what’s really holding you back?

Is it the fear of being told no?
The fear of not being chosen?
The quiet voice that whispers you’re “not good enough,” even though your experience says otherwise?

Sometimes the hardest part of going after a dream isn’t the work—it’s giving yourself permission to try.

We talk ourselves out of opportunities before anyone else ever can. We convince ourselves that now isn’t the right time, that we need one more certification, one more year, one more sign before we’re allowed to take the next step. But deep down, we already know we’re ready.

Growth requires courage. Not the absence of fear—but the decision to move forward despite it.

So ask yourself:

• What am I afraid will happen if I try?
• What am I risking if I don’t?
• Whose approval am I waiting for?

You already know what you want.
You already know what you’re capable of.

The real question is this:
What would happen if you stopped letting fear make the decisions for you?

Many people don’t realize that AAPC offers a Mentor/Mentee Program. I’m proud to say that I am signed up as an AAPC Mentor, and I would love to connect with and support others in achieving their goals—whether that’s certification guidance, career direction, or simply encouragement from someone who’s been there. Or maybe you would like to be a Mentor. Please go and check it out.

If you’re interested, I encourage you to check it out here:
👉 https://www.aapc.com/resources/mentorship-program

Instead of our traditional newsletter, I’m sharing a Coding Tip Sheet—a concise, one-two page resource focused on practical guidance, common pitfalls, and documentation reminders you can use right away.

This approach allows us to deliver clear, actionable education in a format that’s easy to reference and save.

The start of a new year is the perfect time to reset habits, refine processes, and strengthen the foundation of accurate anesthesia coding. When it comes to clean claims and compliant billing, one truth remains constant:

CPT accuracy starts with ICD-10-CM.

While anesthesia coding often focuses heavily on time, units, and modifiers, none of that matters if the underlying diagnosis does not clearly support the service provided.

🔗 Why ICD-10-CM Is the Foundation of Anesthesia CPT Coding

Every anesthesia claim tells a story—and ICD-10-CM codes set the stage. They explain why anesthesia was medically necessary and how complex the patient’s condition truly was.

Strong diagnosis documentation supports:

• Appropriate anesthesia CPT code selection
• Medical necessity for the procedure
• Risk stratification and ASA status
• Audit defensibility

Without clear, specific diagnoses, even perfectly calculated anesthesia time can be challenged.

📌 Common Documentation Gaps That Impact CPT Accuracy

Many anesthesia documentation issues are not coding errors—they’re documentation gaps. Some of the most common include:

• Vague diagnoses such as “abdominal pain” or “back pain” without specificity
• Chronic conditions listed in the history but missing from the final assessment
• Comorbidities documented but not linked to anesthesia risk
• Discrepancies between the surgeon’s diagnosis and the anesthesia record

These gaps make it difficult to assign accurate ICD-10-CM codes, which can ultimately affect CPT code support and reimbursement.

🧠 Linking Diagnosis → Procedure → Anesthesia CPT

Accurate anesthesia coding requires alignment across the entire record:

1. Diagnosis (ICD-10-CM)
   What condition or disease prompted the procedure?
2. Procedure (Surgical CPT)
   What service was performed that required anesthesia?
3. Anesthesia CPT Code
   Does the anesthesia code align with the procedure and patient condition?

When these elements tell the same story, claims are stronger and audits are easier to defend.

⚠️ Diagnosis Specificity Matters More Than You Think

ICD-10-CM specificity isn’t just a surgical concern—it directly impacts anesthesia services. Detailed diagnoses help reflect:

• Increased patient risk
• Complexity of care
• Need for heightened monitoring or intervention

For example, documenting controlled vs. uncontrolled conditions, acute vs. chronic status, or complications can make a meaningful difference in how the case is reviewed.

📋 Documentation Tips for a Strong Start to 2026

As we move into the new year, consider these best practices:

• Ensure diagnoses are carried through from pre-op to final assessment
• Capture all clinically relevant comorbidities impacting anesthesia care
• Encourage consistency between surgeon and anesthesia documentation
• Audit records for diagnosis clarity—not just time and units

Small improvements in documentation can have a big impact on CPT accuracy.

💬 Let’s Start the Conversation

As we begin 2026, take a moment to reflect:

👉 If you could improve one anesthesia documentation issue this year, what would it be?

Drop a comment, reply to this post, or share your experience. Your insight may help another coder, auditor, or provider strengthen their documentation practices.

Here’s to a year of clean claims, strong documentation, and continued growth in anesthesia coding.

The first week of a new year always feels a little different, doesn’t it?
A fresh calendar. New goals. New possibilities.

As anesthesia coders, auditors, and educators, our field is constantly evolving—and staying current takes intention. So I want to hear from you:

👉 How do you plan to make 2026 your best year yet?

Are you:

• 🎓 Working toward a new certification?
• 📚 Enrolling in a course or training to strengthen your skills?
• 🧠 Focusing on mastering a specific area of anesthesia coding or compliance?
• 💡 Exploring education, teaching, or leadership opportunities?
• ⚖️ Prioritizing work-life balance while still growing professionally?

There’s no “right” answer here—growth looks different for everyone. Some years are about pushing forward. Others are about refining what you already know. Both matter.

Drop a comment, reply to this post, or send a message and share what’s on the horizon for you in 2026. Your goals may inspire someone else who’s standing at the same starting line.

Here’s to a year of learning, growth, and supporting one another along the way.
Let’s make 2026 a strong one—together. 💙

2025 was a year of deep reflection for me.

It was the year I finally slowed down enough to ask myself some very hard questions:

• Am I truly happy in my job?
• Am I fulfilled by the company and management I work with?
• Am I satisfied with my certifications and where my career is headed?
• Where do I see myself in one year? Five years?

Some of the answers I uncovered weren’t what I expected. And honestly, it took nearly the entire year before I fully realized what was missing.

What I learned is this: I hadn’t been thinking about me.

Once that realization set in, things began to shift. I started making intentional changes. I clearly defined what I wanted to accomplish for myself—not what was expected of me, not what felt “safe,” but what actually brought me purpose and joy.

Despite all of its ups and downs, 2025 ended on a really good note.
I launched my blog and began welcoming subscribers. I earned an additional certification. I enrolled in the AAPC Instructor Course. Most importantly, I gained clarity—clarity about my goals, my direction, and my why.

With a renewed vision, I’m stepping into 2026 with new expectations and new opportunities. I know that pursuing dreams doesn’t happen overnight. There will be setbacks, and that’s okay. It’s not a race. Growth happens one step at a time, as long as we keep moving forward and continue doing the things that bring us fulfillment.

That brings me to something I want to share with you.

Many people don’t realize that AAPC offers a Mentor/Mentee Program. I’m proud to say that I am signed up as an AAPC Mentor, and I would love to connect with and support others in achieving their goals—whether that’s certification guidance, career direction, or simply encouragement from someone who’s been there.

If you’re interested, I encourage you to check it out here:
👉 https://www.aapc.com/resources/mentorship-program

Let’s make 2026 the best year yet—for our careers, our growth, and for chasing the dreams we’ve been putting off for far too long.

Here’s to learning, evolving, and believing in ourselves.