Anesthesia Coding Alert

One of the biggest challenges with billing for lumbar punctures is determining whether you are billing the service as an anesthesia charge or as a flat-fee surgical charge, says Tonia Raley, CPC, claims processing team leader for the medical billing firm Medical Information Systems in Phoenix. Anesthesiologists are asked to perform these procedures fairly often, as they have had extensive training in placement and management of these types of procedures," she says.
 
Raley adds that it is more common for a physician to perform a diagnostic lumbar puncture under a local anesthetic than to administer anesthesia for the procedure. If the puncture is performed under a local anesthetic, only the physician performing the procedure is present. Because the professional performing the spinal is usually more than able to provide adequate local anesthesia for the procedure, only the procedure is billed no separate fee for anesthesia. But if special circumstances apply (such as treatment of children, severely mentally retarded adults or patients with delirium) and your group is asked to administer an anesthetic as well as perform the procedure, two physicians must be present one to perform the lumbar puncture and the other to provide monitored anesthesia care (MAC) or general anesthesia. In that scenario, bill with the appropriate anesthesia code with base and time units for the physician who provided anesthesia (see below for example codes), along with type-of-service 7 for anesthesia services. Bill as a flat-fee service with the appropriate CPT code and type-of-service 2 for the anesthesiologist who performed the procedure. (Insurance forms include a key designating the different types of service so the appropriate number can be placed in the form's type-of-service box.)

Performing the Puncture

If the anesthesiologist performs the puncture, two procedure codes in CPT Codes 2002 apply: 62270* (Spinal puncture, lumbar, diagnostic) and 62272* (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]). The diagnostic puncture (62270*) is performed most often under a local anesthetic, as Raley notes, so a separate anesthesia code is not filed. When an anesthesiologist administers anesthesia during the procedure, he or she usually bills with 00635 with the appropriate base and time units.
 
If an anesthesiologist administers anesthesia for a diagnostic lumbar puncture, four ASA codes are available: 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture), 00820 (Anesthesia for procedures on lower posterior abdominal wall), **02100 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]) and **02101 (Anesthesia for diagnostic or therapeutic nerve blocks and injections patient in the prone position [when block or injection is performed by a different provider]).
 
Consider two things about **02100 and **02101:

 

These are ASA codes for anesthesia services related to punctures and blocks, not CPT codes. The ASA codes previously assigned to these descriptors (01961 and 01962) are now in CPT, but deal with obstetrical anesthesia instead of nerve blocks and injections.

 

ASA **02100 and **02101 are double-starred procedure codes. Medicare and other government agencies do not recognize double-starred procedure codes, and they do not appear in the anesthesia section of CPT. When you are filing the claim with a government agency such as Medicare, Raley says, use an alternative ASA code for the procedure, such as 00820 or 00635.

If the carrier accepts only CPT codes for anesthesia services, report 00820 or 00635.

Keeping Up-to-Date

Although 00635 was added to the anesthesia section of CPT in 2001, not every carrier accepts it yet. Tammy Caldwell, anesthesia coding team leader for Northern Colorado Professional Services in Fort Collins, Colo., says that many carriers, especially those dealing with workers' compensation cases, are slow to update their systems with new codes. The biggest problem in Medical coding and billing 00635 is justifying the need for anesthesia the insertion of a small needle in the back rarely requires anesthesia services unless there are exceptional circumstances, so be prepared to document why the anesthesia was needed.
 
If your carrier still rejects 00635, use 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) and 00630 (Anesthesia for procedures in lumbar region; not otherwise specified).
 
"Any lumbar puncture walks the line between anesthesia and pain management," Caldwell adds. "It's always difficult to get adequate reimbursement because carriers don't like it when you give anesthesia for these types of procedures."
 
A trend seems to be developing to bill CPT 62272* for these procedures. Raley notes, "This is a separate procedure performed by the anesthesiologist in addition to the administration of anesthesia for the surgical procedure. A drain is placed to help during the surgical procedure for decompression of the brain and for postoperative management. Spinal catheters are also used for postoperative management of some thoracic aortic aneurysms and are often inserted by the anesthesiologist. The anesthesiologist may charge for this in addition to the anesthesia services by appending modifier -59 (Distinct procedural service) to the procedure code and billing with a type-of-service 2 for surgical procedure."