ED Coding and Reimbursement Alert

Question: I was taught that procedures "with anesthesia" take place in the operating room. I also learned that anesthesia in the OR requires mechanical ventilation, whereas with conscious or deep sedation, more commonly seen in the ED, the patient maintains his own airway. Is this information correct? Can I not report "with anesthesia" procedures for ED physicians?

Mississippi Subscriber

Answer: Most payers interpret procedures containing "with anesthesia" in the description as having taken place in the operating room (OR), not the ED. Any physician, however, can provide anesthesia services anywhere. Therefore, an ED physician may use anesthesia codes 00100-01999 in the ED. For example, a patient presents in the ED with a shoulder dislocation. Regardless of whether or not the ED physician uses conscious sedation, the code for this procedure performed in the ED is 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia).

On the other hand, suppose one physician supervises giving Diprivan and fentanyl in support of a second physician performing the reduction. In this case, you would code the services provided by the physician giving the drugs with 01620 (Anesthesia for all closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint). Use 23650 for the services provided by the doctor performing the reduction.

You Be the Coder and Reader Questions reviewed by Mike Granovsky, MD, CPC, CFO.