Anesthesia Coding Alert

Question: Our physician has been asked to administer general anesthesia during a patient's muscle biopsy and also to perform a lumbar puncture while the patient remains under general anesthesia. How should we report this?


Massachusetts Subscriber

Answer: This is a complex question because it involves some potential problems. The lumbar puncture is a surgical procedure - not part of the anesthesia - and should be billed as such. However, the anesthesiologist should not perform a surgical procedure (other than line placements) while administering anesthesia. Find out who handled anesthesia while the anesthesiologist performed the lumbar puncture so you can code appropriately.

Coders' opinions on the actual billing vary. Some recommend that you report anesthesia during the muscle biopsy with 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) and the time involved from start to finish. Code the lumbar puncture separately with 62270 (Spinal puncture, lumbar, diagnostic) and append modifier 59 (Distinct procedural service) to indicate the puncture was separate from the procedure's anesthesia.

However, other coders say this might fall under the multiple-procedure rule because the physician is already administering anesthesia before performing the puncture. Check with your carrier about how to handle the situation before coding it.
  
You Be the Coder and Reader Questions were answered by Kelly Dennis, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla.