Anesthesia Coding Alert

Although CPT Codes 2001 introduced a code for anesthesia during bone marrow aspirations (BMA) (01112, Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest), carriers may reject the code. For ethical, adequate reimbursement, coders should also report the surgical code, the appropriate modifier, or, when anesthesia for BMA is combined with another procedure, the higher-valued procedure, based on carrier preferences.
Carriers Slow to Change
 
 
"Many of the carriers are requiring the surgical and anesthesia codes for BMA," says Cecelia McWhorter, BA, CPC, an anesthesia coder with Comp One Services Ltd. in Oklahoma City. "In the past, we reported the anesthesia with 01120 (Anesthesia for procedures on bony pelvis) because it was the closest anesthesia code to use. Now we have 01112, but carriers can be behind in what they accept for procedures."
 
"Now that 01112 is in place, very few carriers will accept 01120 for BMA," notes Barbara Johnson, CPC, MPC, professional coder with Loma Linda University Anesthesiology Medical Group in Loma Linda, Calif.
New Surgical Code
CPT 2002 also deleted surgical code 85095 (Bone marrow; aspiration only) and added CPT 38220 (Bone marrow aspiration), "so carriers should begin accepting it instead, if that's what they prefer," McWhorter says.
 
Johnson adds that while some carriers request surgical codes rather than anesthesia codes for procedures, these can vary by state and are the exception rather than the rule. If you are dealing with a carrier that wants surgical codes, the new code 38220 would apply.
Using Modifier -23
 
 
When the patient is unable to be still or doesn't understand the necessity of being still during the procedure (such as a child), McWhorter says, modifier -23 (Unusual anesthesia) could apply. Documentation of other factors such as the patient is in a state of constant pain or the patient is having spasms could also help justify anesthesia for the bone marrow aspiration and modifier -23.
 
"Modifier -23 should be used whenever the coder feels that the procedure would not normally require anesthesia but in this case it does," Johnson explains. "More of the BMA anesthesias we perform are for young children, so using modifier -23 tells the carrier that this procedure does not always use anesthesia. The biggest challenge is getting the carrier to understand that these are young children or other patients who are unable to hold still for the procedure without anesthesia."
Situation Becoming More Common
"Normally, we code five or six bone marrow aspirations (BMAs) per month, but recently we have been coding a lot more [...]