Anesthesia Coding Alert

Question: What is the best way to code the second line item on a commercial bill? The diagnosis is 724.02 (Spinal stenosis; lumbar region) for two levels of laminectomy, facetectomy and foraminotomy. Do I report the second segment separately?

Mississippi Subscriber

Answer: The surgical codes for this procedure are 63047 (Laminectomy, facetectomy and foraminotomy [unilateral or bilateral with decompression of spinal cord, cauda equine and/or nerve root(s) (e.g., spinal or lateral recess stenosis)], single vertebral segment; lumbar) and 63048 (... each additional segment, cervical, thoracic or lumbar [List separately in addition to code for primary procedure]). Although the surgeon performed multiple services to more than one segment, the anesthesiologist's service didn't change.

When your practitioner provides anesthesia for a procedure, you only report one code for the service -- even if the surgeon performs multiple tasks. You report the combined time for the entire procedure, but code based on the procedure with the highest base value. Add-on codes such as 63048 are for the surgeon, not the anesthesiologist.

In this case, code based on 63047, which crosses to anesthesia code 00630 (Anesthesia for procedures in lumbar region; not otherwise specified). Though you can't report 63048 for the second segment, remember to report any additional work by the anesthesiologist such as line placement, hypotension monitoring or other non-standard anesthesia services.