Anesthesia Coding Alert

Question: A patient toward the end of her second trimester came to our office with dehydration, kidney stones and pain (which was not being controlled by narcotics). A certified registered nurse anesthetist (CRNA) administered a morphine epidural shot. I billed it with 00820 (Anesthesia for procedures on lower posterior abdominal wall), but it was denied. What would the correct code be, and when should I bill surgical or anesthesia codes?

North Carolina Subscriber

Answer: Differentiating between billing surgical or anesthesia codes can depend on the carrier's preference. Medicare, Blue Cross and others want surgical codes, but some commercial carriers want anesthesia codes. Some coders recommend that pain management services are always billed with surgical codes rather than anesthesia codes. If your physicians are providing anesthesia for a procedure being performed by any other physician, you should bill the anesthesia codes. You should bill surgical codes when the anesthesiologist is acting as the surgeon, such as with A-line placements or similar procedures. The correct surgical code for the situation you describe is 62311 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; lumbar, sacral [caudal]).

Answers to You Be the Coder and Reader Questions are provided by LaSeille Willard, CPC, lead biller with Anesthesia Consultants in Frederick, Md.