Anesthesia Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Should we use anesthesia or surgical codes to report epidural injections (not labor)? Our physicians suggest appending modifier -AA (anesthesia services performed personally by anesthesiologist) or -QZ (CRNA service: without medical direction by a physician) to the claim, depending on who performs the procedure, but our claims are being denied.

New York Subscriber
  Answer: Epidural injections require a surgical, not an anesthesia code, because you are performing the procedure instead of providing the anesthesia. Report the injections with CPT 62310 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62311 (... lumbar, sacral [caudal]), depending on the location.
 
If a neurolytic epidural is used, 62281* (injection/ infusion of neurolytic substance, with or without other therapeutic substance; epidural, cervical or thoracic) or 62282* (... epidural, lumbar, sacral [caudal]) is correct. Do not use modifiers -AA or -QZ because you are reporting services from a surgical rather than an anesthesia standpoint. However, you should append modifier -59 (distinct procedural service) to show the injection was for pain management rather than anesthesia.
 
Use pain as the patient's primary diagnosis and include notes about the procedure with the claim to justify the need for the injection. Possible diagnoses to use for pain include ICD-9 789.00 (abdominal pain, unspecified site), 719.4X (pain in joint; the code's fifth digit depends on the pain's location) and 729.5 (pain in limb). Code V58.49 (other specified aftercare following surgery) could also justify an epidural for postoperative pain management.