Wiki Sedation during Epidural Steroid Injections for Pain Management

[CodingMom2]

Article # L39242:
4. 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.


Per LCD reference article: A58995:
Use of Moderate or Deep Sedation, General Anesthesia, and Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for these procedures and not routinely reimbursable and therefore may be denied. In exceptional circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record individual consideration may be considered on appeal.

I will like additional information on when is it medically necessary for sedation during this procedure​

 

[jkyles]

Sedation would be medically necessary when it would be impossible perform the block unless the patient received the separately reportable sedation or monitored anesthesia care service. For example, the patient is very young or has a movement disorder that means they can't hold still for the duration of the block. (Of course, the MAC reserves the right to say "No.")

Edit: I say the block must be impossible to perform without sedation because that's what Medicare and many private payers require these days. Here is the ASA's statement that offers clinical guidance. https://www.asahq.org/standards-and...ing-interventional-pain-procedures-for-adults