Billing for regional and neuraxial anaesthesia

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By Dr. Simon McLaughlin 

Blocks are becoming more and more prevalent in anaesthetic practice and thankfully the MBS encourages the use of these techniques. There are item numbers that support you performing them as part of your practice. 

Neuraxial and regional techniques in combination with general anaesthesia

If you use a regional or neuraxial technique for a procedure, you can use the associated item number regardless of whether you also give a general anaesthetic or not. For example, if you do a brachial plexus block for upper limb surgery as your sole anaesthetic modality, you can still claim all the item numbers you usually would when you give a general anaesthetic as well as the applicable block item number. 

Neuraxial anaesthesia

If you perform a spinal or epidural as part of your anaesthetic AND it is also of benefit for post-operative pain management, you can claim item number 22031. An example would be the use of intrathecal morphine as part of your single shot spinal. 

If a patient has an epidural in situ and you use it for post operative pain relief, then 22036 applies. An example would be a patient with a labour epidural in situ and requires a Caesarean Section, and you use epidural morphine for postoperative pain relief during their anaesthetic episode. 

Repeated neuraxial or epidural

You can only claim 22031 or 22036 once. They cannot both be used for the same anaesthetic episode. 

Plexus or nerve blocks

Similar to neuraxial anaesthesia, item number 22041 applies for plexus or nerve blocks for post operative pain management. The site of the block must be proximal to the lower leg or forearm and whether the block is a single shot or a continuous catheter technique is not relevant. You can also use 22041 in combination with neuraxial anaesthesia item numbers if applicable. 

Post-operative block maintenance

If you attend to the patient post-operatively to revise a block, be it neuraxial or regional,  item numbers 18222 (less then 15 minutes) and 18225 (greater than 15 minutes) apply. 

Other block item numbers

Section T7 of the MBS has individual item numbers (182xx) for specific blocks. These are stand-alone procedures and cannot be claimed in conjunction with an episode of anaesthesia. If you perform a block outside of theatre, you can claim the T7 item number for the corresponding block along with a referred consultation item number (17640 or similar) if applicable. In this situation, you cannot co-claim any 2xxxx item numbers. 

Blocks and rvg item numbers

If you are using RVG item numbers instead of MBS item numbers such as for WorkCover cases, you can also claim CV805 if you use ultrasound to assist in performing the block. 

Solo Practice Management can provide expert advice on how best to utilise the MBS. We have billing guides for beginners or for members we are on hand for any questions you may have. For more information, give us a call or see our website at