Hi! My name is Dianne C. Moseley. I’m a healthcare professional with over 32 years of experience in revenue cycle management. Throughout my career, I’ve worked in every area of RCM, gaining a true understanding of how each part connects to the bigger picture.
I am currently certified through AAPC with my CPC, CPCO, CPMA, and CANPC.
For the past 15 years, I’ve focused my expertise on anesthesia — a specialty I’m deeply passionate about. I currently work with a large anesthesia group, as a Senior Auditor serving as a Subject Matter Expert, where I focus on optimizing coding accuracy, compliance, education, and revenue integrity. My passion lies in education, process improvement and helping others to succeed.
This blog is a space where I will share practical insights, tips, and real-world guidance on anesthesia coding. My goal is to make complex concepts clear, support continuous learning, and help others feel confident navigating the anesthesia coding landscape.
The Anesthesia 101 Webinar is designed to provide foundational education for anesthesia coders, auditors, and revenue cycle professionals. These sessions review key anesthesia coding concepts, documentation essentials, and practical guidance to support accurate coding and compliant billing.
One-lung ventilation (OLV) is a specialized anesthetic technique commonly used during thoracic surgical procedures to allow the surgeon access to the operative lung while the other lung continues to provide ventilation and oxygenation. For anesthesia coders, understanding how and when OLV is used helps clarify why certain anesthesia CPT codes apply—particularly ASA 00541.
One-lung ventilation (OLV) is a ventilation technique where one lung is intentionally collapsed (the operative lung) while the other lung continues to be ventilated by the anesthesiologist. This technique improves surgical exposure and safety during thoracic procedures.
Collapsing the operative lung allows better visualization of the surgical field, more space for surgical instruments, reduced movement from lung expansion, and improved precision during thoracic surgery.
OLV is achieved using lung isolation techniques. The two most common methods are:
1. Double-Lumen Endotracheal Tube (DLT) – A specialized airway tube with two lumens allowing independent ventilation of each lung. 2. Bronchial Blocker – A device inserted through a standard endotracheal tube to block ventilation to one lung.
OLV is frequently required for thoracic procedures such as lobectomy, pneumonectomy, thoracoscopy (VATS), esophageal surgery, mediastinal procedures, lung biopsy, decortication, and bullectomy.
ASA 00541 describes anesthesia for thoracotomy procedures involving the lungs, pleura, diaphragm, and mediastinum. One-lung ventilation is included in the anesthesia service when performed and is not billed separately.
– OLV is included in the anesthesia service – It is not separately billable – Code selection is based on the surgical procedure – Documentation should reflect the thoracic procedure requiring lung isolation
When reviewing anesthesia records, coders may see terms such as: double-lumen tube placed, lung isolation achieved, bronchial blocker used, one-lung ventilation initiated, or operative lung collapsed for surgical exposure.
While one-lung ventilation is not coded separately, recognizing it in the anesthesia record helps coders understand the complexity of thoracic anesthesia services and supports appropriate anesthesia CPT code selection.
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 governing body.
Every reasonable effort has been made to ensure the accuracy of the information provided at the time of publication. However, coding guidelines, regulations, and payer policies are subject to change. It is the responsibility of the reader or participant to verify current guidance and apply professional judgment when making coding and billing decisions.
*Anesthesia for hernia repairs in the lower abdomen not otherwise specified; younger than 1 year of age – 00834
Anesthesia for hernia repairs in the lower abdomen not otherwise specified; infants younger that 37 weeks gestation age at birth and younger than 50 weeks gestational age at time of surgery – 00836
Introduction The sacroiliac (SI) joint is a well-recognized source of low back and buttock pain. Due to its complex anatomy and variable innervation, diagnosing SI joint–mediated pain can be challenging. Sacroiliac joint nerve blocks play a critical role in both diagnosing and treating this condition. CPT code 64451 was created to more accurately describe injections targeting the nerves innervating the sacroiliac joint rather than intra-articular injections.
Anatomy and Innervation of the SI Joint The sacroiliac joint receives sensory innervation primarily from the L5 dorsal ramus and the lateral branches of the S1, S2, and S3 sacral nerves. These nerves transmit pain signals from the posterior sacroiliac ligaments and joint capsule. Because innervation patterns can vary among patients, imaging guidance is essential to accurately target these nerves.
Indications for SI Joint Nerve Blocks Sacroiliac joint nerve blocks may be performed for both diagnostic and therapeutic purposes. Diagnostic blocks typically involve the injection of a local anesthetic to confirm the SI joint as the pain generator. A positive response is usually defined by significant temporary pain relief. Therapeutic blocks may include a corticosteroid to reduce inflammation and provide longer-lasting symptom relief.
Procedure Overview The procedure is typically performed with the patient in the prone position. After sterile preparation, fluoroscopic or CT imaging is used to guide needle placement to the L5 dorsal ramus and S1–S3 lateral branch nerves. Contrast is often used to confirm appropriate needle placement prior to injection of anesthetic and/or steroid medication. Imaging guidance is an inherent component of CPT 64451.
Coding Considerations for CPT 64451 CPT 64451 describes injection(s) of anesthetic agent(s) and/or steroid into the nerves innervating the sacroiliac joint, including imaging guidance. This code should be reported only when all relevant nerves supplying the SI joint are targeted. If fewer nerves are injected, other codes such as 64450 may be more appropriate depending on documentation and payer policy.
It is important to note that imaging guidance is included in the code descriptor and should not be reported separately. When the procedure is performed bilaterally, modifier -50 may be required unless payer-specific rules dictate otherwise. Documentation should clearly identify the nerves treated, laterality, imaging modality used, and medications injected.
Common Documentation Pitfalls Incomplete documentation is a frequent cause of denied or downcoded claims. Common issues include failure to identify all nerves injected, lack of imaging confirmation, or vague descriptions such as “SI joint injection” without clarification of nerve versus intra-articular approach. Coders and auditors should carefully review procedure notes to ensure CPT 64451 is fully supported.
Conclusion CPT 64451 represents an important advancement in accurately coding sacroiliac joint nerve blocks. Understanding the anatomy, clinical intent, and documentation requirements is essential for compliant reporting. When properly supported, this code allows for accurate reimbursement while reflecting the complexity of the procedure performed.
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 governing body.
Every reasonable effort has been made to ensure the accuracy of the information provided at the time of publication. However, coding guidelines, regulations, and payer policies are subject to change. It is the responsibility of the reader or participant to verify current guidance and apply professional judgment when making coding and billing decisions.
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 cardiac events are preventable with healthy lifestyle changes and early intervention.
What This Means for Auditors & Coders
While clinicians focus on prevention and treatment, auditors and coders play a critical role behind the scenes. February is an ideal time for us to pause and take a closer look at the cardiovascular procedures we code and audit.
This is our opportunity to ensure coding is fully supported by documentation, aligned with current CPT, ASA, and ICD-10-CM guidelines, and compliant with payer and regulatory requirements.
Cardiac cases often involve complex procedures, multiple components, bundled services, and documentation that may imply details rather than clearly state them. That complexity can increase both compliance risk and missed revenue opportunities if we are not diligent.
A Coding Challenge for the Month
As part of American Heart Month, challenge yourself to review at least one cardiac procedure you frequently encounter. Revisit the documentation requirements, validate the coding guidelines, and ask yourself whether the record would withstand an external audit.
Let’s Start the Conversation
What type of heart-related procedure tends to trip you up the most when coding or auditing? Is it cardiac catheterizations, electrophysiology studies, CABGs, TEEs, or something else? Sharing these challenges helps us learn from one another and strengthen our coding accuracy.
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 governing body.
Every reasonable effort has been made to ensure the accuracy of the information provided at the time of publication. However, coding guidelines, regulations, and payer policies are subject to change. It is the responsibility of the reader or participant to verify current guidance and apply professional judgment when making coding and billing decisions.
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 L1 spinal nerve and provide sensory innervation to the lower abdominal wall, groin, and upper thigh region. Because of their close anatomical relationship, these nerves are frequently targeted together to manage post-operative pain.
Common procedures where these blocks may be used include:
• Inguinal hernia repairs
• Cesarean sections
• Appendectomies
• Gynecologic and lower abdominal surgeries
Single Injection vs. Two Separate Blocks
From a clinical standpoint, these nerves may be anesthetized with one injection at a single fascial plane or with two injections targeting each nerve individually. This distinction is critical for coding purposes.
Just because two nerves are involved does not automatically mean two separately billable blocks.
Coding Considerations
When ilioinguinal and iliohypogastric nerve blocks are performed, they are commonly reported as a single abdominal wall nerve block. When performed together via the same injection site, only one block is typically supported.
Separate reporting may only be considered when documentation clearly supports distinct injections, separate needle placements, and medical necessity for treating each nerve independently.
Documentation Elements to Look For
To support appropriate billing, the anesthesia record should include:
• Identification of the nerves blocked
• Laterality (if applicable)
• Technique used (ultrasound guidance or landmark-based)
• Number of injections and needle placements
• Purpose of the block (post-operative pain management)
Auditor’s Perspective
From an audit standpoint, the key is combining clinical reality with documentation support. If the record reflects one injection targeting both nerves with no distinction between separate techniques, reporting a single nerve block is generally appropriate.
This is another area where coding is not always black and white and where professional judgment plays an important role.
Final Thoughts
Ilioinguinal and iliohypogastric nerve blocks are effective tools in post-operative pain management, but they require careful review when it comes to coding and compliance. Understanding anatomy, technique, and documentation expectations helps ensure accurate reporting and audit defensibility.
Educational Use Disclaimer: This material is for educational purposes only and does not constitute billing or legal advice. CPT and coding guidance should always be applied in accordance with payer-specific policies and official guidelines.
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 governing body.
Every reasonable effort has been made to ensure the accuracy of the information provided at the time of publication. However, coding guidelines, regulations, and payer policies are subject to change. It is the responsibility of the reader or participant to verify current guidance and apply professional judgment when making coding and billing decisions.
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 white. Sometimes, it lives in the gray.
Professional coding is not about searching for magic words. It’s about understanding the medicine, the intent of the service, and the clinical story the record is telling. If coding were simply a word-search exercise, professional judgment wouldn’t matter — but it does.
There will be records where:
• The service is clearly performed, but the wording isn’t textbook
• The documentation supports the work, even if it doesn’t say it the way we wish it would
• The clinical picture makes sense when viewed as a whole, not as isolated phrases
Expecting every record to explicitly state every detail in the exact language we want before allowing a service to be coded or billed is unrealistic — and it doesn’t reflect how medicine is practiced.
That’s where professional judgment comes in.
Professional judgment means:
• Applying coding guidelines with clinical knowledge
• Reviewing the entire record — not just one sentence
• Understanding what is reasonably inferred versus what is truly missing
• Knowing when documentation supports a service and when it genuinely does not
This doesn’t mean we stretch the rules or ignore compliance. It means we apply them thoughtfully.
As auditors and coders, our role isn’t to deny everything that isn’t perfectly worded — nor is it to approve everything without scrutiny. Our responsibility is to balance compliance, accuracy, and clinical reality.
The gray area will always exist. The key is knowing how to navigate it responsibly.
Because at the end of the day, coding is not just about words on a page — it’s about understanding the story behind them.
Disclaimer: Chart Talk: Anesthesia Coding Conversations is intended for educational and informational purposes only. The content shared does not constitute legal, billing, compliance, or reimbursement advice. Coding, billing, and reimbursement decisions should be based on official sources such as CPT®, ICD-10-CM, ASA guidelines, payer policies, and individual facility policies, as well as the specific documentation in the medical record. Users are encouraged to consult authoritative resources and/or their compliance department for guidance applicable to their organization.
