Anesthesia Coding Alert

Question: Our physician used conscious sedation during a child's bone marrow aspiration. Can he only bill 99141 for the case? It was more work-intensive than usual, but I didn't think I could report modifier -22 with the conscious sedation codes.

California Subscriber

Answer: Remember that while you can add conscious sedation codes +99100 (Anesthesia for patient of extreme age, under 1 year and over 70 [list separately in addition to code for primary anesthesia procedure]) and 99141 (Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) to any surgery code, many carriers do not recognize or reimburse for them. And any reimbursement you might get from some carriers will probably be minimal. Appending modifier -22 (Unusual procedural services) is not likely to increase your revenue or even get 99141 reimbursed.

You can include 99141 if your physician also performed the bone marrow aspiration; code the procedure with 38220 (Bone marrow; aspiration only) or 38221 (... biopsy, needle or trocar) as appropriate. You can report both procedures if the physician performs an aspiration and biopsy at separate sites or at separate patient encounters. If he performs both procedures at the same site through the same incision, you should only report the bone marrow biopsy.

If your physician only provided anesthesia for the procedure, report anesthesia code 01112 (Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest) instead.