Orthopedic Coding Alert

Question: My orthopedist wants proof that when a procedure code states, -with anesthesia,- this means general anesthesia only and not local. Where can I find this information in writing?

Wisconsin Subscriber Answer: You can find your answer in CPT's surgery guidelines. According to CPT, the normal surgical package includes -local infiltration, metacarpal/metatarsal/digital block or topical anesthesia.-
 
Consequently, the normal -without anesthesia- codes, such as 24600 (Treatment of closed elbow dislocation; without anesthesia), include locals, blocks and topicals, but not general anesthesia. If the code indicates -requiring anesthesia,- as with 23655 (Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia), the physician has to provide a service over and above a local, meaning a general.  -- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.