Anesthesia Coding Alert

Question: Is it appropriate to bill monitored anesthesia care (MAC) anesthesia for a caudal epidural administered by a separate provider? I don’t see an anesthesia crosswalk code for 62322.

Pennsylvania Subscriber

Answer: The correct answer depends on whether the caudal epidural (62322, Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance) is administered for postoperative pain or for general pain management.

If the epidural is given for pain management, cross it to either anesthesia code 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position) or 01992 (… prone position), depending on whether the patient is in prone position during the procedure. Code 01991 carries three base units; code 01992 carries five. As anesthesia is not normally required for this procedure unless it is a child, make sure your documentation supports medical necessity.

If the epidural is performed for post-op pain, it is not billable with MAC anesthesia. You should report the appropriate anesthesia code for MAC and not submit an additional code, although you can capture the time it took to place the block.

Also note: You cannot report 01991 or 01992 in conjunction with moderate sedation services:

• 99151-+99153 (Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status …)
• 99155-+99157 (Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports …)

Note: Please be sure to include the following RQ about kyphoplasty in the issue; it’s part of the CEU quiz. Thanks!