Radiology Coding Alert

Question: If the radiologist performs hip arthrography and documents using 1 percent lidocaine, should I report 27093 or 27095?

California Subscriber

Answer: Code 27093 (Injection procedure for hip arthrography; without anesthesia) is the appropriate code.

The "with anesthesia" in 27095 (... with anesthesia) refers to general anesthesia. And lidocaine is a local anesthetic.

Support: AMA's CPT Assistant (April 2005), referring to 23700 (Manipulation under anesthesia, shoulder joint, including application of fixation apparatus [dislocation excluded]), states that "code descriptors, which include the phrase 'requiring anesthesia' or 'under anesthesia,' indicate that the work involved in that specific procedure requires the use of general anesthesia."

Also, CPT's surgery guidelines indicate that the normal surgical package includes "local infiltration, metacarpal/metatarsal/digital block or topical anesthesia."

- Consequently, the normal "without anesthesia" codes, include locals, blocks and topicals, but not general anesthesia. If the code indicates "with anesthesia," the physician has to provide a service over and above a local, meaning a general.

Don't forget: You should report the radiological supervision with 73525 (Radiologic examination, hip, arthrography, radiological supervision and interpretation).