Anesthesia Coding Alert

Question: How should we code when our anesthesiologist provides MAC while another physician (in another practice group) administers cervical or lumbar epidurals? The procedure codes cross to 02100 (Anesthesia for diagnostic or therapeutic nerve block or injection), but this isn't accepted because it is not in CPT.

North Carolina Subscriber

Answer: Reimbursement in these situations can be hit or miss, depending on the carrier and the specific case. Many of the codes that some practitioners try to file are actually "open" codes, meaning they represent procedures where an incision was made. Because of this, the most appropriate code is probably 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) appended with modifier -52 (Reduced services). Reduce the base units for the procedure by one or two, depending on the patient's circumstances and the complexity of the case. Medical necessity for the anesthesia often becomes an issue with these procedures, so include a copy of the anesthesia record (and a note from the requesting physician, if possible) with the claim to verify the need for anesthesia and help improve your chances of reimbursement.

You Be the Coder and Reader Questions were reviewed by Tammy Caldwell, anesthesia coding team leader with Northern Colorado Professional Services in Fort Collins, Colo.