The autocoder codes peripheral nerve blocks and neuraxial catheters on anesthesia cases. A block either becomes part of the time-based anesthesia service, or it becomes a separate flat-fee line. This page describes the checks that drive that decision.

## When a block bills separately

The autocoder reads three things from the record for every block.

1. The indication. It looks for an explicit post-operative pain purpose, such as "postoperative pain control" or "post-op analgesia".
2. Surgeon involvement. It looks for an order or a request from the surgeon.
3. The operative anesthesia mode for the surgery, read from the anesthesia record rather than from the block note.

A block documented as the primary anesthetic bills as time. A block with a post-operative pain indication and a documented surgeon order or request becomes a separate line with modifier 59, after the mode check passes. Neuraxial catheters (62324-62327) and single neuraxial injections (62320-62323) pass the mode check only when the operative anesthesia was general. Peripheral blocks (the 644xx family) pass when the operative anesthesia was general, spinal, or epidural. When the mode does not qualify, the autocoder marks the block non-billable and records the reason, and an `anes_procedure_bundled` alert appears.

Two documentation gaps change the outcome. A post-operative pain indication with no surgeon order or request bills as time, with a note that the surgeon involvement is not documented. An undocumented operative mode keeps the block billable and flags it for review of the mode conditions. A spinal placed in the operating room is never a separate line.

The checks above are the standard configuration. Your facility configuration can change them -- from requiring order language only, up to replacing the whole separate-billing decision with your organization's own billing rules. If your claims follow different rules than this page describes, your facility runs such a configuration. Contact your Hank representative to review or change it.

## Paravertebral block units

For single-injection paravertebral blocks, the autocoder codes the first injection site as 64461. It codes the second site and any additional sites as ONE unit of 64462, whatever the number of levels. It never repeats 64462. A continuous paravertebral catheter becomes 64463 instead of 64461 and 64462, not in addition to them. Bilateral placement adds modifier 50.

## The documentation gate

Your facility can require specific documentation evidence before a separately billed post-operative pain block stays on the claim. The `postOpPainBlockDocumentation` setting names the evidence per payer type: a surgeon order or request, a transfer-of-care acceptance, a completed consult, a signed block-specific consent, or a separate procedure note. The autocoder scans the whole record for those elements after it builds the claim.

The gate ships turned off. When it is on and evidence is missing, your configuration decides between two outcomes. The block stays billable and a `postop_block_doc_evidence_missing` alert names the payer, the evidence found, and the evidence missing. Or the block moves to the bundled list and a `postop_block_doc_demoted` alert explains why. Records that contain handwritten documents never move to the bundled list automatically, because the scan cannot confirm marks on paper. If the scan itself fails, billing stays untouched and a `postop_block_doc_scan_error` alert appears.

## Diagnoses on the block line

A separately billed block line does not inherit every diagnosis on the encounter. The `nerveBlockLineIcds` setting selects the policy, and the default is `g89_only`. Under `g89_only`, the line carries only the G89-family pain codes from its own extraction, normally G89.18. Under `g89_plus_site`, the line also keeps the site or pain code extracted for that block. Under `copy_all`, the block line behaves like every other line. Contact your Hank representative to change the policy. If a block line ends with no diagnosis, a `line_item_no_icd` alert fires at severity 10.

## How this reaches you

What happens next depends on how your organization consumes HANK CODES. In HANK Claim Maker, a COMPLIANCE alert flags the claim for the compliance team your administrators configured for it. Organizations that consume the coding API directly decide in their own workflow which alerts pause a claim, who reviews them, and when a claim is released.