Anesthesia Coding Alert

Question: At our children’s hospital, the anesthesiologists have been asked to provide general anesthesia during muscle biopsies and/ or MRIs, as well as perform a lumbar puncture under general anesthesia during the same session. I’m wondering if the lumbar puncture is separately billable. In this case, I’m billing for the anesthesia being provided for multiple procedures, one of which the anesthesiologist would perform himself. I thought there was a rule somewhere that you couldn’t bill for both, but I can’t find it.

Ohio Subscriber

Answer: Children often require anesthesia services for procedures where a normal adult patient does not, and most insurance companies recognize the situation. For a rule about billing “for both,” there are a couple of possibilities.

Highest based unit: You may be thinking of the anesthesia coding rule regarding billing the highest based unit when the patient has multiple procedures or services during the same anesthesia case. If the treating physician is performing the MRI and/or muscle biopsy AND the lumbar puncture under general anesthesia, the highest based rule would apply.

The anesthesia code for the MRI is 01922 (Anesthesia for non-invasive imaging or radiation therapy). Both the American Society of Anesthesiologists and Medicare assign 7 base units to 01922. Anesthesia codes for muscle biopsy services vary, but they have 3 to 5 base units depending on the muscle location. You do not consider the lumbar puncture anesthesia for the reasons explained below. That means you should report 01922 for the encounter because it has the highest number of base units.

Anesthesia and procedure: In the situation you describe, the anesthesiologist is performing a surgical procedure (62270, Spinal puncture, lumbar, diagnostic) and general anesthesia for an MRI (01922). You may report both documented services as these codes are not bundled under National Correct Coding Initiative (NCCI) edits. Depending on the payer, you still may need to use a modifier, such as 59 (Distinct procedural service) or XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service), to indicate the procedure was separate and distinct from the anesthesia service.

But be careful not to include the time for the lumbar puncture in the anesthesia time. Reporting anesthesia time for the lumbar puncture would be double dipping. The lumbar puncture likely takes only a few minutes, and the anesthesiologist should be sure to document the time for the lumbar puncture separately. You should deduct that time from the anesthesia time.

Here’s why: Medicare’s National Correct Coding Initiative Manual, Chapter II, Section A, states, “Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure.” So, you can report the anesthesia services for the MRI and/or biopsy, but you shouldn’t include the lumbar puncture in the anesthesia time.