Anesthesia Coding Alert

Question: The physicians in our practice contract with an ambulatory surgery center (ASC). Sometimes they perform sedation and monitoring for other pain management physicians (outside our group) for certain procedures, mostly nerve destruction and radiofre-quency procedures. What is the best way to submit for these procedures? Georgia Subscriber Answer: Sedation and monitoring lean toward monitored anesthesia care (MAC). You could use codes 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) or 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified), depending on exactly what procedure the pain physician is performing. Remember to code to the highest level of specificity and ensure that the anesthesia coding appropriately crosses to the surgical procedure code. For example, a neurosurgeon performs a Luschka block (61790, Creation of lesion by stereotactic method, percutaneous, by neurolytic agent [e.g., alcohol, thermal, electrical, radiofrequency]; gasserian ganglion). This surgical code crosswalks to the anesthesia code 00300.

Unlike reimbursement for surgical codes, which is based on relative value units, carriers calculate anesthesia reimbursement using the base units for the code plus time units. Code 00300 has five base units. Most carriers calculate time units in 15-minute increments, although some may use 12-minute increments. CPT 2003 lists two new codes to address pain blocks provided by a separate anesthesia provider: 

01991 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); other than the prone position
01992 Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different provider); prone position.