Welcome to the Chart Talk Blog — a place for conversations about anesthesia coding, auditing, documentation, compliance, anatomy, and the real-world challenges coding professionals encounter every day. Explore recent articles, educational series, coding discussions, and practical insights designed to help us continue learning together.
Latest from Chart Talk
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February Is American Heart Month — and a Perfect Time for Coding Reflection
Today marks the first day of February, and with it comes American Heart Month—a crucial time to raise awareness about cardiovascular disease, the leading cause of death in the United States. Since 1964, this national observance has focused on prevention through monitoring blood pressure, making heart-healthy nutrition choices, and staying physically active. Nearly 80% of…
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Ilioinguinal and Iliohypogastric Nerve Blocks: What Coders Need to Know
Post-operative pain management continues to evolve, and ilioinguinal and iliohypogastric nerve blocks are commonly used regional techniques—particularly for lower abdominal procedures. While clinically effective, these blocks often raise coding and documentation questions, especially when they are performed together. What Are Ilioinguinal and Iliohypogastric Nerve Blocks (CPT 64425)? The ilioinguinal and iliohypogastric nerves originate from the…
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Coding Isn’t Always Black and White — Sometimes It Lives in the Gray
In a perfect world, every medical record would contain clear, explicit language, neatly documented exactly the way coders want to see it. Every required element would be spelled out. Every box would be checked. But those of us who live in the real world of coding know better. Not everything in coding is black and…
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Erector Spinae Plane (ESP) Block
Another week, another opportunity to learn something new in anesthesia pain management. This week’s spotlight focuses on an unusual but increasingly common technique used for post-operative pain control: fascial plane blocks—with a special focus on the Erector Spinae Plane (ESP) block. What Is a Fascial Plane Block? Fascial plane blocks are regional anesthesia techniques where…
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Sciatic Nerve Block – CPT codes 64445 & 64446
DISCLAIMER: Chart Talk: Anesthesia Coding Conversations is intended for educational and informational purposes only. The information presented reflects the sole interpretation and professional opinion of the presenter. It does not represent the views or official guidance of my employer, the Centers for Medicare & Medicaid Services (CMS), the American Medical Association (AMA), or any other regulatory or…
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Hypothermic Circulatory Arrest (HCA): When Is ASA 00563 Appropriate?
Hypothermic circulatory arrest (HCA) is one of the most complex and high-risk techniques used in cardiac and major vascular surgery. Because of its complexity—and its frequent confusion with hypothermia alone—it is also an area where anesthesia coding errors commonly occur.This post breaks down what HCA is, how it differs from hypothermia without arrest, and when ASA code 00563…
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Brachial Plexus, Axillary, and Suprascapular Nerve Block
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…
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Post-Op Pain Blocks Series: Introduction
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…
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How Anesthesia Charges Are Calculated
1. Base Units • Assigned by ASA to each anesthesia CPT code. • Represent procedure complexity. • Fixed amount—does not change with case duration. 2. Time Units • Begins when anesthesia care starts; ends when no longer personally providing services. • Most payers: 1 unit = 15 minutes. • Medicare: billed based on actual minutes.…
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What Constitutes “Instrumentation” in Spinal Cases ~ ASA 00670
In spinal surgery, instrumentation refers to any hardware implanted into the spine to provide stability, correction, or fixation. It is used to immobilize spinal segments, maintain alignment, or support fusion. Common Types of Spinal Instrumentation 1. Pedicle Screws 2. Rods 3. Plates 4. Interbody Devices (Cages) 5. Hooks 6. Wires / Cables 7. Crosslinks Coding Note (If You…
