Item 2800 and 2802 as part of anaesthesia.

2800 - Plexus nerve block

2802 - Peripheral nerve block

The motivation for the use of one of these codes in addition to that for the "normal" anaesthesia is that it controls post operative pain and minimises the use of pain injections/ medication and encourages early mobilisation.

It is reasonable if the injury / surgery is of sufficient nature to expect much pain post operatively, such as in the fracture of a long bone that was surgically reduced and fixated.

It is however not reasonable in cases of a simple fracture to a hand bone / foot bone or uncomplicated amputation of a finger / toe or other simple procedures.

Examples of claims where I have found the use reasonable:

• open reduction / internal fixation of a femur / tibia-fibula / humerus / radius – ulna

• total knee replacement / total hip replacement

Examples where the use of the codes is not reasonable:

• one fracture in the hand / foot treated surgically

• amputation finger / toe or part of finger / toe

• arthroscopy of the ankle / knee / shoulder

I have seen one claim for a "crushed foot" where I accepted the use of the code because of many fractures and multiple procedures in one operation.

Item 2800 and 2802 as part of treatment.

There also are instances where the use of the codes is part of the treatment (no surgery performed and is not part of general anaesthesia as such). This is why the codes were put into the tariff structure in the first place.

Multiple rib fractures are treated with a nerve block for pain management and that would be acceptable.