March 29, 2018

Question:
We have a question about codes in orthopaedics that include references about anesthesia.  Specifically, we are asking about CPT codes, 27093 and 27095.   If our surgeon injects a local anesthetic subcutaneously and into the hip joint prior to a hip arthrogram, is this with or without anesthesia?”

Answer:
Thanks for your question as this topic has created \ confusion for years.

CPT codes 27093 and 27095 addressed in your question are defined as follows:

27093: Injection procedure for hip arthrography; without anesthesia.

27095: Injection procedure for hip arthrography; with anesthesia.

Based on your description, KZA recommends reporting CPT code 27093 the code that states, “without anesthesia.”

Source: “Anesthesia for Fracture Care and Other Musculoskeletal Services” CPT Assistant January 2018

According to the AMA, use of local anesthetics is not considered “anesthesia.”  References to anesthesia are used as a measure of the complexity of the service (eg, “without anesthesia,” “requiring anesthesia,” “under anesthesia”).

These references to anesthesia in the musculoskeletal system codes are not intended to replace the reporting of the administration of anesthesia by a separate physician or qualified health care professional, but they are intended as a proxy to indicate the complexity of the service, instead.

For purposes of coding, use of local anesthetics is not considered “anesthesia.” If an orthopedic injury is treated only using local anesthesia, treatment should be reported using a code that does not specify “with anesthesia.”

*This response is based on the best information available as of 03/29/18.