Anesthesia Coding Alert

Question: Our anesthesiologist was present during an ORIF (open reduction internal fixation) of an ankle. The surgeon also used fluoroscopy during the procedure. Which of the surgeon's services should I base the anesthesia code on?

Washington Subscriber

Answer: The surgeon probably used fluoroscopy (76000, Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) to confirm the fixation device placement while the patient was under general anesthesia. Fluoroscopy crosses to the 7-unit code 01922 (Anesthesia for non-invasive imaging or radiation therapy). The main procedure crosses to the 3-unit code 01480 (Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified).

Anesthesia coders normally bill cases based on the higher-unit procedure performed, but there are exceptions. The fluoroscopy is the higher-base procedure in this case, but your physician probably administered anesthesia during the ORIF rather than during the fluoroscopy. You're better off coding according to the highest base value that justifies anesthesia -- the ORIF -- with 01480.