Pain Management

[enancy79]

How do you (or can you) bill for a pain management injection (ie 62311)performed by one member of the CRNA group and a second charge for MAC anesthesia during the injection by another member of the same group?

[jdrueppel]

The provider performing the MAC can bill 01991 or 01992 (depending on pt positioning) plus time if anesthesia documentation guidelines (complete anesthesia record) have been met. Make sure you have documentation of medical necessity of anesthesia for this procedure as the payer may request before allowing benefits.

Julie, CPC

[DevonaG]

Can you suggest where the documentation should be in the patient record? Is this something we need to create - most payers are still denying as incidental even with the anesthesia record

[jdrueppel]

First, make sure the anesthesia provider is performing MAC versus conscious sedation (CPT 99148-99150). Second, are these services occurring in a "facility setting" - 99148-99150 are not billable in an office setting. Third, check the payer policy - Medicare and larger payers have MAC local coverage determinations which may be causing the denials.

If it is indeed MAC, the provider performing the epidural should be documenting the medical necessity as to why monitored anesthesia care is needed. The CRNA has essentially become the surgeon and therefore must request and provide medical rationale for the MAC. This (these) diagnosis would then be reported as secondary dx on the anesthesia claim. In addition, you may want to review the -23 modifier which is for unusual anesthesia. I must say I do not believe that MAC is routinely required for epidural steroid injections - it should be a rare occurrence that MAC is necessary for this service.

Hope this helps.
Julie, CPC