Anesthesia Coding Alert

Question: How do we report the anesthesia service when the CPT® code is classified as "anesthesia care typically not required," but the physician used something other than general anesthesia?

Kentucky Subscriber

Answer: The anesthesia Crosswalk includes quite a few codes classified as "anesthesia care not typically required," such as 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]). Some of the codes in this classification inherently include anesthesia (such as 27605, Tenotomy, percutaneous, Achilles tendon [separate procedure]; local anesthesia).

Even if a CPT® code is designated as one not typically requiring anesthesia, it doesn't mean the anesthesia service can't be reported. You might be able to report the applicable anesthesia code as usual and append modifier 23 (Unusual anesthesia). You should include all documentation supporting the need for anesthesia.

Caveat: When you read the full description for modifier 23, you see that it applies to cases with general anesthesia. If the physician uses some other type of anesthesia (like a regional block), that rules out applying modifier 23 (unless the payer specifically requests modifier 23 even in this instance). You'll need to rely on the diagnoses they physician assigns to explain and support why anesthesia was used. For example, a patient with Parkinson's disease (332.x) might need anesthesia in order to remain still during an injection or MRI.