Anesthesia Coding Alert

A number of surgical codes are included in CPT 2000 for special bone procedures requiring anesthesia, such as bone biopsies or bone marrow aspirations. Anesthesia coders dont run into many problems selecting the most appropriate code for these procedures if the patients carrier will accept surgical codes from an anesthesia provider. The problems arise when the carrier will only accept anesthesia codes from anesthesia providers, and coders are not sure which codes should be used.

Surgical or Anesthesia Codes?

As with most procedures, the first question a coder should ask is whether the carrier in question will accept surgical codes from an anesthesia provider for the services offered. If so, Cheryl Pascale, CMA, CCS, a coder with Hackensack Anesthesiology Associates, a group of 38 anesthesiologists in Hackensack, N.J., says the following codes can be considered for these types of procedures.

Bone biopsy: 20220-20245 (biopsy, bone, trocar or needle; biopsy, bone, excisional and biopsy, vertebral body, open) Patients who are diagnosed with neoplasms, leukemia or osteomyelitis may undergo a bone biopsy.
Bone marrow biopsy: 85102 (bone marrow biopsy, needle or trocar) Bone marrow biopsies are often performed on patients who have leukemia.
Bone marrow aspiration: 85095 (bone marrow, aspiration only) Marrow aspirations also may be performed on patients with leukemia.
Spinal tap: 62270 (spinal puncture, lumbar, diagnostic) This procedure may be used on a patient who is experiencing neoplasms, fever or convulsions.

Lots of carriers such as Medicare, Oxford and Aetna/U.S. Healthcare, won’t take surgical codes for anesthesia services, Pascale points out. Thats when you have to start trying to figure out which anesthesia codes fit best.

Deciding on the best anesthesia code can be challenging for a number of reasons, according to Pascale. As with many procedures, one challenge is getting the anesthesia providers to document their services correctly and thoroughly. She adds that the biggest challenge often is working with the American Society of Anesthesiologists (ASA) crosswalk to file with the recommended anesthesia codes that correspond to surgical codes. She cites the following challenges with filing procedures with the surgical codes listed above, along with possible codes to use instead.

Challenge 1: Cross-referencing codes

The ASA crosswalk cross references code 20220 (biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum,spinous process, ribs]) with the primary ASA code 00454 (biopsy of clavicle) with a base of three units, along with nine alternate codes. Pascale says one of these codes is not recognized by the American Medical Association (i.e., it is not included in CPT) and the others have varying base units associated with them. The [...]