Anesthesia Coding Alert

Question: Can you explain why the CROSSWALK^® for 35190 doesn’t list 01270 for an upper leg anesthesia code? I’ve checked with the surgeon and reviewed the operative report, and the listed code and alternate code suggestions don’t fit. What should I do?

Arkansas Subscriber

Answer: The American Society of Anesthesiology’s (ASA’s) CROSSWALK^® is intended as a guide but may not offer all applicable codes. According to the introduction section of the 2023 CROSSWALK^® (page vi, third paragraph), “The listing of a CPT^® procedure code with a CPT^® anesthesia code does not limit or restrict use of an alternate or unlisted code.”

So, if you determine, based on your knowledge of coding, that an override of the suggested code(s) is appropriate, you may do so and instead select an anesthesia code that more accurately represents the anesthesia service. Note the CROSSWALK^® comment under code 35190 (Repair, acquired or traumatic arteriovenous fistula; extremities): “Selection of either the primary anesthesia code or of an alternate is determined by the site of the surgical procedure.” Thus, your coding can be based on the anatomical site of the surgical procedure.

Note: You can email a proposed change form to the American Society of Anesthesiologists (ASA) at CROSSWALK@asahq. org.