Wiki Moderate Sedation in Pain Management Payable?

[schanderson]

Good day,

I now have another physician at my office that does anesthesia on the patients and performs the service. My understanding is that I bill out the claim with the modifier 47 on the moderate sedation code, which our office is using the 99152 for the patient. I have tried to research about moderate sedation and have only found articles about gastroenterology coding and nothing about pain management/ neurology billing. Our office just received a denial for 99152 on our procedure code 64493 and 64494 from Medicare. I know certain procedures Medicare deems sedation unnecessary is this case with this procedure or is it the modifier?

 

[jkyles]

Hi there, you need to review the LCD for facet joint interventions that went into effect in 2021.

General anesthesia is considered not reasonable and necessary for facet joint interventions. Neither conscious sedation nor monitored anesthesia care (MAC) is routinely necessary for intraarticular facet joint injections or medial branch blocks and are not routinely reimbursable. Individual consideration may be given on redetermination (appeal) for payment in rare, unique circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record. Frequent reporting of these services together may trigger focused medical review.

 

[schanderson]

Hi there, you need to review the LCD for facet joint interventions that went into effect in 2021.

I see it now thank you for pointing me in that direction.