Anesthesia Coding Alert

Question: The surgeon performed a closed reduction and placement of a spanning external fixator device to the patient’s right lower extremity. The postoperative diagnosis is right tibial plateau fracture with intra-articular extension and posterior condylar split. The diagnosis is for the tibia, but the higher anesthesia code is for the femur – and this was an extremely involved procedure. The surgical code is 20690. Should I report 01360 or 01392 for the anesthesia?

Missouri Subscriber

Answer: Always code based on the procedure and documentation, not what will bring the highest reimbursement. That’s why you should not submit 01360 (Anesthesia for all open procedures on lower one-third of femur) – because it applies to the femur and this procedure was on the tibia. In this situation, the correct anesthesia code for fixation of a bicondylar fracture of the proximal tibia is 01392 (Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella) with four base units.

Pay attention to details: The primary anesthesia code listed for surgical code 20690 (Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system) is 01830 (Anesthesia for open or surgical arthroscopic/endoscopic procedures on distal radius, distal ulna, wrist, or hand joints; not otherwise specified). This is not appropriate in your situation, however, because you’re not coding for fixation of the radius or ulna. CPT^® 2022 includes nine other options as alternate anesthesia codes for 20690. One of these is 01392, which is the most accurate since it applies to the upper ends of the tibia, fibula, or patella.