Ob-Gyn Coding Alert

Question: What is the correct coding policy to follow when local anesthesia is administered during an in office surgical procedure? The particular example we are concerned about is when the physician administers local lidocaine for a stenotic cervix during an endometrial biopsy or an incision and drainage of a Bartholins cyst? In addition to the procedure code would it be acceptable to use the CPT 00940 code for anesthesia for vaginal procedures?

Colleen Rusoff, Brielle Ob/Gyn, Manasquan, NJ

Answer: There may be extra work in administering a local anesthetic to manage cervical stenosis during an office procedure, especially if multiple local injections are given. But, according to the CPT, all surgical procedures include the administration of topical or local anesthesia as part of the surgical package. You would add the cost of materials to your fee for doing the procedure.

The 00940 code would only be used by an anesthesiologist providing appropriate anesthesia, other than local, for vaginal procedures not otherwise specified. In the unusual circumstance in which a surgeon also administers anesthesia other than a local, topical or a metacarpal block for a procedure he/she is performing, you would attach the modifier -47 (anesthesia by surgeon) to the procedure code without using an anesthesia code.

Note: This modifier requires that the physician administer the anesthesia, not the office nurse. Also, most insurers do not reimburse the operating physician for anesthesia administration.