Anesthesia Coding Alert

A number of surgical codes are included in CPT 2000 for special bone procedures requiring anesthesia, such as bone biopsies or bone marrow aspirations. Anesthesia coders dont run into many problems selecting the most appropriate code for these procedures if the patients carrier will accept surgical codes from an anesthesia provider. The problems arise when the carrier will only accept anesthesia codes from anesthesia providers, and coders are not sure which codes should be used.

Surgical or Anesthesia Codes?

As with most procedures, the first question a coder should ask is whether the carrier in question will accept surgical codes from an anesthesia provider for the services offered. If so, Cheryl Pascale, CMA, CCS, a coder with Hackensack Anesthesiology Associates, a group of 38 anesthesiologists in Hackensack, N.J., says the following codes can be considered for these types of procedures.

Bone biopsy: 20220-20245 (biopsy, bone, trocar or needle; biopsy, bone, excisional and biopsy, vertebral body, open) Patients who are diagnosed with neoplasms, leukemia or osteomyelitis may undergo a bone biopsy.
Bone marrow biopsy: 85102 (bone marrow biopsy, needle or trocar) Bone marrow biopsies are often performed on patients who have leukemia.
Bone marrow aspiration: 85095 (bone marrow, aspiration only) Marrow aspirations also may be performed on patients with leukemia.
Spinal tap: 62270 (spinal puncture, lumbar, diagnostic) This procedure may be used on a patient who is experiencing neoplasms, fever or convulsions.

Lots of carriers such as Medicare, Oxford and Aetna/U.S. Healthcare, won’t take surgical codes for anesthesia services, Pascale points out. Thats when you have to start trying to figure out which anesthesia codes fit best.

Deciding on the best anesthesia code can be challenging for a number of reasons, according to Pascale. As with many procedures, one challenge is getting the anesthesia providers to document their services correctly and thoroughly. She adds that the biggest challenge often is working with the American Society of Anesthesiologists (ASA) crosswalk to file with the recommended anesthesia codes that correspond to surgical codes. She cites the following challenges with filing procedures with the surgical codes listed above, along with possible codes to use instead.

Challenge 1: Cross-referencing codes

The ASA crosswalk cross references code 20220 (biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum,spinous process, ribs]) with the primary ASA code 00454 (biopsy of clavicle) with a base of three units, along with nine alternate codes. Pascale says one of these codes is not recognized by the American Medical Association (i.e., it is not included in CPT) and the others have varying base units associated with them. The definition for 00454 is for biopsy of clavicle, which means you cannot use it to code for procedures on any other bones.

Most billing software will cross reference to the first ASA code listed, she explains. So if a patient has a biopsy of the iliac crest, the coder or data entry person inputs 20220. The software crosswalks to ASA code 00454 at three base units, but in reality the anesthesia code that should be used is 01120 (anesthesia for procedures on bony pelvis) with a base of six units. Coders should be careful to ensure that the correct amount of base units is charged for the procedure.

Many other anesthesia codes are cross referenced from surgical codes 20220-20245, but coders still should be careful of which ones they choose. For example, 00630 (anesthesia for procedures in the lumbar region; not otherwise specified) is included in this group of cross referenced codes. Some anesthesia coders say using this code for a spinal tap or lumbar puncture is incorrect because it implies an open procedure. Two other options for coding spinal taps or lumbar punctures when using anesthesia codes rather than surgical codes include:

00300 (anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck and posterior trunk, not otherwise specified) along with modifier -52 (reduced services). Code 00300 is basically for an open procedure, so Pascale recommends adding the modifier -52 to show the procedure code is accurate but that you are reducing base units because it was not an open procedure.
01999 (unlisted anesthesia procedure). Some carriers deny this code on the grounds that unlisted procedures do not exist, but others will accept it with backup documentation explaining the procedure performed.

Challenge 2: RVG Value

Codes 85102 and 85095 have no corresponding listings in the Relative Value Guide (RVG) for anesthesia services. With no RVG value, there is no start-up or base unit amount for anesthesia providers to include with their time units associated with the procedure. This means that these particular codes usually are not associated with anesthesia, so anesthesia services are unlikely to be reimbursed, according to Scott Groudine, MD, chair of the Government, Legal and Economic Affairs Committee of the New York Anesthesia Society.

You should, therefore, submit claims with a code from the anesthesia section of CPT instead of a surgical code.

Challenge 3: Spinal Taps

For spinal taps, the ASA guide crosswalks to code 01951 with alternate codes of 01952 (both related to the lower abdominal wall) and 00820 (anesthesia for procedures on lower posterior abdominal wall). One problem is that 01951 and 01952 are not included in CPT. Another is that the ASA crosswalk and Relative Value Guide list different base units for the codes (three units in Crosswalk and five units in the pain management section of RVG). The third problem for Pascale is that the code that will be accepted, 00820, is not an accurate description of the procedure. Her group opts for code 00630 (anesthesia for procedures in the lumbar region; not otherwise specified) with a base of eight units.

Tough Question to Answer

Groudine and Pascale agree that coding for these procedures is difficult. They advise coders to pay attention to the providers documentation and to submit claims with appropriate codes in terms of the procedure performed and associated base units. They advise coders to work closely with their local carriers to learn which codes are accepted in which situations, so claims can be filed accurately.