Pediatric Coding Alert

Question: How should we code to get reimbursed for anesthetic administration when performing laceration repair?

New York Subscriber

Answer: Generally, you cannot. The anesthetic administration is bundled into laceration repair (12001-13160), CPT states. The surgical package clearly delineates the kind of anesthesia included in the surgery code. The definition states that local infiltration, metacarpal/metatarsal/digital block or topical anesthesia is always included in the surgery.
 
Moreover, the laceration repair codes represent surgical procedures and consequently fall under the guidelines of the surgical package definition. Even minor repairs, which are starred procedures such as 12001* (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less), include the anesthesia.
 
You should not assume that you can bill separately for what seems like a separate procedure, especially in pediatrics. Administering a lidocaine injection to a 4-year-old can require more skill and time than the repair itself, but it is still not separately billable. The asterisk means that if the physician also provides an E/M service, you can bill that service as well. Laceration repair is surgery, and anesthesia is bundled into it.
 
You may be wondering why you can bill for a nerve block (CPT 64450 ) with a circumcision (54150) but cannot bill for lidocaine administration with laceration repair. First, CPT bundles the lidocaine administration; there is no code for local infiltration. Second, regional nerve blocks are not included in the definition of the surgical package, which is restricted to local infiltration, metacarpal/metatarsal/digital blocks or topical anesthesia.
 
  You Be the Expert reviewed by Richard Tuck, MD, FAAP, practicing pediatrician with Primecare Pediatrics of Zanesville, Ohio.