Anesthesia Coding Alert

Question: Which anesthesia code will Medicare accept for kyphoplasty? Other spinal codes have much higher base values, so I'm not comfortable using them. Is the best option to use 00630 (Anesthesia for procedures in lumbar region; not otherwise specified) with modifier -52 (Reduced services)?

Colorado Subscriber

Answer: Most anesthesiologists prefer to use 00630 in this case because kyphoplasty is a higher-valued procedure than a skin procedure or anesthesia for an injection; plus, kyphoplasty itself is not limited to the skin and is not an injection.

Code 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) limits the procedure depth to skin, integumentary system, muscles and nerves. Because kyphoplasty is invasive enough to attain a level below muscle and nerve, you should use 00630, or 00640 (Anesthesia for closed procedure on cervical, thoracic or lumbar spine) if the carrier accepts ASA-only codes. Modifier -52 could also be used when reporting the procedure, but remember that's reducing the physician's services.