Anesthesia Coding Alert

Question: Is it permissible to provide and bill for monitored anesthesia care (MAC) services (including monitoring and sometimes IV sedation) provided by our group of nurse anesthetists for pain management procedures such as caudal or epidural blocks? The doctor who performs the blocks is either an orthopedic surgeon or an anesthesiologist who does not employ or work in the same group as the CRNAs, but has requested the MAC anesthesia service. The MAC charge would be billed by the CRNA group.

Boston subscriber

Answer: Yes, you can bill, as long as you include documentation of 1) medical necessity, since most people dont need MAC for pain injections, and 2) the doctors request for MAC. If the insurance company recognizes codes 01951 (anesthesia for diagnostic or therapeutic nerve blocks and injections) and 01952 (anesthesia for diagnostic or therapeutic nerve blocks and injections with patient in the prone position) from the American Society of Anesthesiologists (ASA) Relative Value Guide, use whichever is appropriate. If the insurance company does not recognize these codes, file it under code 01999 (unlisted anesthesia services and procedures) instead. This is the catch-all code for anesthesia procedures that do not have a specific CPT code. Be sure to include all documentation of the procedure whenever you use 01999 so you have proof of the work that was done.