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anesthsia for IV infusion in facility

  1. #1
    Default anesthsia for IV infusion in facility
    Medical Coding Books
    I have a case where our anesthesiologist provided the MAC sedation for a 14 yo patient w/ severe autism (violent outbursts), chiari malformation and autoimmune deficiency, while the IV Infusion of Gammagard was done. My MD stayed with the patient, monitoring, charting, etc for the full 4 + hours of infusion as prescribed by the patients PCP. The service was provided in the PACU of the hospital. I want to use the 96365 but there isn't a crosswalk. Would using 01999 be appropriate in this case, while sending all documentation available? I think the unusual circumstance of this case would meet the medical necessity, but am looking for confirmation from others. Has anyone else dealt with this?

  2. #2
    I would use the 01999-23 (unusual anesthesia) and then send all the information with this. I use this anesthesia code for children when they have to be placed into an MRI or CT machine and they are sedated. Always use the -23 modifier to show that this procedure does not usually require anesthesia but that this was special circumstance.
    Amy Pritchett,
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

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