Anesthesia Coding Alert

Question: I'm confused about how to report a knee manipulation with anesthesia. The anesthesiologist marked both MAC (monitored anesthesia care) and epidural on the chart. The operative report states, "Epidural with augmentation with brief intravenous general mask." What is the correct way to code this?

Massachusetts Subscriber Answer: Begin by asking your physician about the case - never just go by the operative report, especially when you aren't sure about the situation. Several coding possibilities exist, all of which will affect your coding in different ways.
 
If your physician used general anesthesia, base the claim on surgical code 27570 (Manipulation of knee joint under general anesthesia [includes application of traction or other fixation devices]); this crosses to anesthesia code 01380 (Anesthesia for all closed procedures on knee joint).
 
If the anesthesiologist administers sedation or MAC after placing a spinal or epidural, the anesthetic is the primary regional block because it's providing the majority of anesthesia for surgery. That means you'll still report 01380.