Anesthesia Coding Alert

Reader Questions:

Compare Base Unit Values Before Billing Bone Grafts

Published on Mon Sep 11, 2023

Question: With bone grafts, we code for the body part the graft is going to and not the bone graft itself, as the repair includes obtaining the graft, right? One of our docs wants to bill for the bone graft in a case involving metatarsal nonunion fracture repair with iliac bone graft, and I’m not sure this is appropriate. Can you explain whether I should bill for the fracture repair or the bone graft?

Colorado Subscriber

Answer: When reporting anesthesia services, code the highest-based (most difficult/complex) procedure. Metatarsal fracture repair — whether open (01480 (Anesthesia for open procedures on bones of lower leg, ankle, and foot …)), closed (01462 (Anesthesia for all closed procedures on lower leg, ankle, and foot)), or arthroscopic (01464 (Anesthesia for arthroscopic procedures of ankle and/or foot)) — is three base units. An iliac bone graft (01112 (Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest)), however, provides two additional units. At five base units, 01112 is the highest-based code and, thus, the one you should bill.

Plus: According to the comments under 01112 in the 2023 Relative Value Guide^®(RVG), the code may be reported when a graft is obtained from the iliac crest.