Primary Care Coding Alert

Reader Question:

Choose 23650 Over 23655 for Local Anesthesia

Published on Tue Jan 10, 2012

Question: One of our physicians administered a shot of meperidine HCL while treating a shoulder dislocation. I'm not sure whether "anesthesia" always means conscious sedation with IVs and such. Should we consider this a manipulation with or without anesthesia when coding?

North Dakota Subscriber

Answer: Your coding choices are 23650 (Closed treatment of shoulder dislocation, with manipulation; without anesthesia) and 23655 (... with anesthesia). The "anesthesia" referenced in code 23655's descriptor represents general anesthesia, which is supported by the RVU difference (3.53 work RVUs for 23650 versus 4.76 work RVUs for 23655). This interpretation is also supported by the fact that the CPT® surgical package definition includes "local infiltration, metacarpal/metatarsal/digital block or topical anesthesia," so the specification of "anesthesia in a code descriptor always implies something more than that. Because your physician simply anesthetized the site in order to manipulate the shoulder, report 23650.

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