Orthopedic Coding Alert

Question: I administered anesthesia to a patient before performing a bunionectomy and Chevron osteotomy. How should I report both the anesthesia and the surgery together?

California Subscriber

Answer: Assuming that you performed regional or general anesthesia and not conscious sedation, you should append modifier -47 (Anesthesia by surgeon) to your surgical code. If you perform a regional femoral nerve block, for example, you should report 28296-47 (Correction, hallux valgus [bunion], with or without sesamoidec-tomy; with metatarsal osteotomy [e.g., Mitchell, Chevron, or concentric type procedures]) along with 64447 (Injection, anesthetic agent; femoral nerve, single).

The May 1997 CPT Assistant states that modifier -47 "alerts the third-party payer to the fact that the surgeon personally performed the anesthesia Under no circumstances should the -47 modifier be appended to the anesthesia procedures."