Wiki Anesthesia for ESI (pain management procedures)

[phillipmanning]

With the new Medicare LCD's kicking in for ESI's and also the part about anesthesia being rarely, if ever, necessary embedded within the LCD's, I'm curious if any groups that have provided anesthesia in the past for these procedures (even if not on a "routine" basis) will continue to do so? Just let the documentation speak for itself? Or stop altogether? The recommendation to have patients sign an ABN but I think we all know how that will fly.

Thanks in advance for all input,
Mark

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Mark Manning
President & CEO Medical Management Services Inc
Columbus GA
(706) 660-8505 EXT 104
markmanning@mybillingguy.com

 

[jeskla]

I work for an ortho practice that has a pain management doc also and bill TFE's and LESI's all the time but have never billed anesthesia codes with them. I've been working with his team to make sure our documentation supports the new Medicare LCD, but its been a bit difficult. I was just reading the LCD and did noticed what you were speaking about:

"Use of Moderate or Deep Sedation, General Anesthesia, and Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for these procedures and therefore not considered medically reasonable and necessary.16 Even in patients with a needle phobia and anxiety, typically oral anxiolytics suffice. In exceptional and unique cases, documentation must clearly establish the need for such sedation in the specific patient."

Yet, AMA came out with 6 new codes for spinal procedures effective 1/1/22: 01937- 01942, wouldn't the above restriction apply to those codes?

 

[jkyles]

Yet, AMA came out with 6 new codes for spinal procedures effective 1/1/22: 01937- 01942, wouldn't the above restriction apply to those codes?

True, but the new LCD isn't changing long-standing requirements for MAC with interventional pain management procedures. If you have patients who - for example - can't follow directions, MAC will still be covered.

 

[jeskla]

Thank you for the comment. I work in an office setting and my pain management doc is an anesthesiologist. I was afraid I would need to learn these new anesthesia codes (and modifiers) to use with his spinal injections. But I feel silly now for thinking that.

 

[jkyles]

It's not silly at all, the new policies are confusing.