Anesthesia Coding Alert

Of the spinal anesthesia codes available, only CPT 00670 specifically mentions extensive procedures and instrumentation. So how do you code for procedures that are extensive but are not vascular and do not include instrumentation?

"I use the ASA Crosswalk as a guide for using 00670 on extensive cases," says Bea Olson, an anesthesia and pain management coder with Integrity Consulting in Phoenix. "You can use 00670 for extensive procedures that are not instrumentation or vascular, but you need to have documentation of how extensive the case is. I train the anesthesiologists to know that procedures that are designated as 'extensive' should be backed up by the operative report and extended time for the procedure."

When could this type of situation come into play? Following are just two examples of when 00670 may be billed even if instrumentation isn't used:

The planned procedure included insertion of hardware such as Harrington rods, but that portion of the procedure was abandoned due to the patient's condition (such as a change in cardiac status or in spinal cord monitoring). Although the hardware was not inserted because of other problems, the surgery was still extensive and the spine was extensively operated on to accept the rods.

Any time a large portion of spine is dissected, it almost always means the surgeon plans to insert hardware or remove a vascular lesion. Instrumentation is virtually universal for nonvascular extensive spine surgery. If the surgeon did not place hardware, find out what procedure codes he is billing, and then cross them to the appropriate anesthesia codes. If you are unhappy with the cross code and feel that the documentation supports an extensive case, you could still code with 00670. Another approach would be to use the crosswalk code and add modifier -22 (Unusual procedural services) when the services provided are greater than what is usually required for the listed procedure.