Anesthesia Coding Alert

Question: I bill for anesthesiologists in a children’s hospital. A small child was taken to the OR and anesthetized so the physician could place a nasogastric tube. What do I report for the anesthesia?

Pennsylvania Subscriber

Answer: The physician placing the tube will report 43752 (Naso- or oro-gastric tube placement, requiring physician’s skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report)). CPT^® does not include a corresponding anesthesia code because the tube placement does not typically require anesthesia — but coding for procedures on children changes that.

Here’s why: A small child will require anesthesia to perform almost any procedure that requires them to stay still and calm. Because of this, children usually are excluded from “do not require anesthesia” procedure guidelines.

In your situation, you might submit anesthesia code 00160 (Anesthesia for procedures on nose and accessory sinuses; not otherwise specified). Another option might be 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified). Although the procedure technically is not on the nose or mouth, the anesthesiologist must place the tube through each of the orifices to reach the stomach for feeding.

Plus: The child’s age as documented in the record is usually enough to justify anesthesia in this type of situation. However, if your provider administered general anesthesia and the insurer recognizes modifier 23 (Unusual anesthesia), you can append it to the claim. Modifier 23 is an informational modifier that, if applicable, would be reported after any primary payment modifiers.