Anesthesia Coding Alert

One of the biggest challenges with billing for lumbar punctures is determining whether you are billing the service as an anesthesia charge or as a flat-fee surgical charge, says Tonia Raley, CPC, claims processing team leader for the medical billing firm Medical Information Systems in Phoenix. Anesthesiologists are asked to perform these procedures fairly often, as they have had extensive training in placement and management of these types of procedures," she says.
 
Raley adds that it is more common for a physician to perform a diagnostic lumbar puncture under a local anesthetic than to administer anesthesia for the procedure. If the puncture is performed under a local anesthetic, only the physician performing the procedure is present. Because the professional performing the spinal is usually more than able to provide adequate local anesthesia for the procedure, only the procedure is billed no separate fee for anesthesia. But if special circumstances apply (such as treatment of children, severely mentally retarded adults or patients with delirium) and your group is asked to administer an anesthetic as well as perform the procedure, two physicians must be present one to perform the lumbar puncture and the other to provide monitored anesthesia care (MAC) or general anesthesia. In that scenario, bill with the appropriate anesthesia code with base and time units for the physician who provided anesthesia (see below for example codes), along with type-of-service 7 for anesthesia services. Bill as a flat-fee service with the appropriate CPT code and type-of-service 2 for the anesthesiologist who performed the procedure. (Insurance forms include a key designating the different types of service so the appropriate number can be placed in the form's type-of-service box.)
Performing the Puncture
If the anesthesiologist performs the puncture, two procedure codes in CPT Codes 2002 apply: 62270* (Spinal puncture, lumbar, diagnostic) and 62272* (Spinal puncture, therapeutic, for drainage of cerebrospinal fluid [by needle or catheter]). The diagnostic puncture (62270*) is performed most often under a local anesthetic, as Raley notes, so a separate anesthesia code is not filed. When an anesthesiologist administers anesthesia during the procedure, he or she usually bills with 00635 with the appropriate base and time units.
 
If an anesthesiologist administers anesthesia for a diagnostic lumbar puncture, four ASA codes are available: 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture), 00820 (Anesthesia for procedures on lower posterior abdominal wall), **02100 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]) and **02101 (Anesthesia for diagnostic or therapeutic nerve blocks and injections patient in the prone position [when block or injection is performed by a different provider]).