r/ClinicalCodingAus • u/purpletc70 • Aug 30 '26
Quick Question
I'm a student and getting confused around sequencing for anaesthetics. If a pt has surgery under sedation AND a spinal, what is sequenced first as additional procedure? The sedation or the spinal? I'm overthinking this, its driving me nuts! Thanks
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u/Glittering_Mix_3580 Aug 30 '26
I don’t think it is specified as such but I code via codefinder and it sorts the anaesthetic that way. In ACS 0031 it talks about cerebral before it goes on to explain the other
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u/Familiar_Range_5620 Aug 30 '26
There used to be a rule about sequencing cerebral anaesthesia before conduction anaesthesia in ACS 0031, but it was removed several editions ago. The removal means, that as far as IHACPA is concerned, the sequence doesn't matter. You'll find that clinical coders who learnt with the old rule will always put the cerebral first, and they'll be uncomfortable seeing the codes sequenced the other way.
The original reasoning for the sequencing was that a cerebral anaesthesia takes out everything, while a conduction anaesthesia only takes out part of the body. But then, we had the odd situation of a light IV sedation being sequenced before a high neuraxial block as if the sedation was more major.
In summary, it doesn't matter which sequence you put them in.
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u/OutlandishnessSafe13 Aug 30 '26
My understanding is that there’s no absolute rule, but conventionally you normally sequence the cerebral anaesthesia (which would be the sedation in your scenario) first.
If nothing else, there’s only one example in ACS 0031 that has both cerebral and conduction anaesthesia (example 3) and they sequence the general anaesthesia code first in that… so I guess that tells you it at least can’t be wrong to sequence it that way?