Anesthesia Coding Alert

Question: A patient presents at the emergency department (ED) with a post spinal procedure headache. (He had a spinal procedure earlier in the day or on another day.) The anesthesiologist examines the patient and decides to do a blood patch epidural. Can he charge for a consult and the blood patch procedure? What modifiers should we use?

Gina Morris
Central Kentucky Anesthesia

Answer: You may be able to bill for the blood patch (62273*, injection, epidural, of blood or clot patch), but some carriers may not allow you to bill for the consult as well (the carrier may say that the patient is an existing patient and is in the immediate postoperative period). If you opt to try for consult reimbursement, consider using the appropriate evaluation and management (E/M) code, such as 99241 (office consultation for a new or established patient, which requires a problem focused history; a problem focused examination; and straightforward medical decision making)with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Modifier -25 would be used only if the consultation was done on the same day as the spinal procedure. If the two procedures are performed on different days, simply code with 99241, assuming both procedures were performed by the same anesthesiologist. Code 349.0 (reaction to spinal or lumbar puncture) would be an appropriate diagnosis code to use. Work with your carrier to determine what they will reimburse in your area.

At the same time, it is important to note that many experts would consider it an unusual practice to perform a blood patch on the same day as a causative spinal. It is less successful when done on the same day, and most people would try a conservative treatment such as hydration, analgesics and caffeine for a while before going to the surgical approach.