# CRNA services for pain management



## bearybubba2008 (Jun 23, 2014)

Good morning, all!
I am new to pain management billing and I was wondering if I could get some help. We just hired a part time CRNA to do anesthesia for some of the procedures we do in our office such as nerve blocks etc for pain management. It looks like the codes to be billed would be 01991 and 01992, depending on the position the patient is in for the procedure. Would there be any additional codes for time? I think I know what I'm doing but then I start to second-guess myself on everything since I am so new to this...
Thanks in advance for any help!


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## sramirez1968 (Jun 23, 2014)

Good Morning Beth, 
If the patient is in Prone position you would bill 01992 with the appropriate modifier:
QX - Anesthesia, CRNA Medically directed
QZ - Anesthesia CRNA not Medically directed.
Also, If you bill QZ, then you will bill QY for the Anesthesiologist (MD)
QY - Medical Directon of on CRNA by an anesthesiologist.

Hope this helps,
Samantha Ramirez 
CPMC


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## hgolfos (Jun 24, 2014)

Some pain procedures cross to 01935 or 01936 such as the transforaminal epidurals and radiofrequency ablations.  Also, be sure to advise your providers to document the medical necessity for anesthesia, as most pain procedures can be done without it or under moderate sedation.


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## brinktwins (Jun 25, 2014)

I also work for a Pain Management office.  This is a very good question!  I agree the importance for documentation is crutial.  However, we do a lot of moderate sedation injections (99144 & 99145) vs. MAC and I haven't found the trick to getting these paid either.  It is documented on Medicare's website that they don't always reimburse for these codes, but I can't find any documentation anywhere that tells me what guidelines to follow.  I've tried several modifiers, I've called Medicare and BCBS, no one seems to be able to find a specific document that can assist me with these codes.  Does anyone know something that may help me out with this?

Thank you in advance!


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## hgolfos (Jun 26, 2014)

We've never filed the moderate sedation codes with mods, and have been paid.  The important thing is to have documentation of the time and monitoring of the patient by qualified personnel.  

For instance if your provider does a lumbar facet joint injection:

64493-LT
99144
721.3

The 99144 & 99145 are used if the same provider is doing the procedure AND sedation.  If you have a different provider doing the sedation you should use codes 99149 & 99150.

Additionally CPT indicates for time based codes like these your total time has to go past the halfway mark, so for 99144 which indicates 30 minutes you have have at least 16 minutes of monitoring documented in order to bill it. (see Time on pg XV in the introduction to CPT)

Hope this helps!


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