Anesthesia Coding Alert

Question: A 29-year-old female patient presented with a nonunion closed fracture of the lower end of her left tibia. The surgeon performed a tibial plateau repair with an autograft from the lower one-third of the femur using a separate incision to obtain the graft.

The surgeon reported 27724. What are the ASA CROSSWALK^® code selections for 27724, and what is the correct highest-based anesthesia code to assign? I was told that the surgeon’s reported code may not have the highest value for anesthesia.

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Answer: Anesthesia CROSSWALK^® code selections for 27724 (Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)) are:

• 01392 (Anesthesia for all open procedures on upper ends of tibia, fibula, and/or patella), base 4;
• 01112 (Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest), base 5; and
• 01480 (Anesthesia for open procedures on bones of lower leg, ankle, and foot; not otherwise specified), base 3.

Since the surgeon did not obtain the graft from the iliac crest, 01112 does not apply. The base values for 01392 and 01480 are four and three, respectively, but another higher-valued code applies in this case.

Key: The surgeon obtained a graft from the lower one-third of the femur through a separate incision. While the surgeon cannot list a separate CPT® code for the graft because it is bundled with 27724, that does not apply to anesthesia. You are allowed to apply the highest-based anatomical ASA code.

Bottom line: The ASA code with the highest base value and, thus, the correct one to report in this case is 01360 (Anesthesia for all open procedures on lower one-third of femur), with an anesthesia base unit value of five.