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20680, Removal of implant;
deep (eg, buried wire, pin, screw,
metal band, nail, rod or plate).
Transversus abdominis plane
(TAP) local anesthesia block
(for example, abdominal plane
block, rectus sheath block) is a
procedure that is performed on
patients who undergo abdominal
and/or pelvic surgery for
postoperative pain control and
abdominal wall analgesia. The
TAP block is a peripheral nerve
block applied to anesthetize the
sensory nerves of the anterior
abdominal wall. The intention
of this procedure is to allow
the instilled local anesthesia
to access multiple branches
of several different nerves
(for example, ilioinguinal,
iliohypogastric, subcostal,
intercostal) by using a single
injection technique thereby
providing a dermatomal
sensory block over the six
lower thoracic and first lumbar
afferents. 4 Medicare global
surgery rules prevent separate
payment for postoperative pain
management when provided
by the physician performing
an operative procedure. 5
Therefore, a TAP block (64486–
64489) may not be reported
by a surgeon in conjunction
with an abdominal operation,
including hernia repair.
When reporting an unlisted
code to describe a procedure
or service (such as 49659,
Unlisted laparoscopy procedure,
hernioplasty, herniorrhaphy,
herniotomy), it is necessary
to submit supporting
documentation (procedure
report) along with the claim to
provide an adequate description
of the nature, extent, and need
for the procedure, and the time,
effort, and equipment necessary
to provide the service.
ACS Coding Hotline
If you or your coding staff
have questions, contact the
ACS Coding Hotline at 800-
ACS-7911 (800-227-7911). The
hours of operation are 8:00
am–5:00 pm (Central), Monday–
Friday, holidays excluded. ACS
Fellows are given five free
consultation units (CU) each
calendar year. One CU covers
a period of up to 10 minutes.
In addition, ACS Surgical
Coding Workshop opportunities
are available for surgeons and/
or their coding staff. For more
information or to sign up for one
of the 2017 ACS Surgical Coding
Workshops, visit facs.org/advocacy/
practmanagement/workshops. ♦
REFERENCES
1. Senkowski C, Jackson J. Coding hernia
and other complex abdominal repairs.
Bull Am Coll Surg. 2011;96( 9): 42-44.
2. Savarise M. Hernia and abdominal
wall coding. In Savarise M,
Senkowski C, eds. Principles of Coding
and Reimbursement for Surgeons.
Switzerland: Springer; 2017:238-239.
3. American Medical Association.
Current Procedural Terminology 2017
Professional Edition. Chicago, IL:
American Medical Association;
2017:82.
4. American Medical Association.
Transversus abdominis plane block
(64486-64489). CP T Asst Am Med Assoc.
2015; 25( 6): 3.
5. Centers for Medicare & Medicaid
Services. Medicare Claims Processing
Manual. Chapter 12: Physicians/
nonphysician practitioners. Available
at: www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/
Downloads/clm104c12.pdf. Accessed
February 28, 2017.
