Anesthesia Coding Alert

Question: What anesthesia code should we report for removal of hardware from the humeral shaft? The surgical code is 20680. This crosses to primary anesthesia code 01360, but I think 01630 is a better fit. What do you recommend?

West Virginia Subscriber

Answer: You are correct that surgical code 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) is associated with primary anesthesia code 01360 (Anesthesia for all open procedures on lower one-third of femur). However, you are not required to report the primary anesthesia code if one of the associated secondary codes is more accurate.

Keep in mind that when there are multiple anatomical selections available, such as in this case, it is up to the coder to determine the correct anatomical site and not assign the first code that appears in the crosswalk.

That is the case in your situation: Code 01630 (Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; not otherwise specified) is a more accurate anesthesia code, based on the information you share. Submit 01630 with complete documentation of the service. Codes 01360 and 01630 both carry five base units, so that piece of your reimbursement calculations will remain the same.

Explanation: Remember, the shoulder is made up of three bones: the humerus (upper arm bone), the scapula (the shoulder blade), and the clavicle (the collarbone). During procedures represented by 01630, the anesthesia provider induces the patient and monitors the patient during the procedure to the humeral head and neck, sternoclavicular, acromioclavicular, and shoulder joints that a surgeon performs.