# Anesthesia for pain managment



## beatet66 (Jun 3, 2013)

Hello,
could anybody lead me to something in writing regarding the proper anesthesia codes to use for pain managment procedures; anesthesia and procedures are provided by two separate providers.
I had recently advised my providers to use CPT 01991 or 01992 for Diagnostic or Therapeutic nerve blocks or injections, depending on the positioning of the patient during the procedure, such as Facet blocks or TFESIS, and CPT 01935/01936 for image guided procedures, such as RFA, SCS trials and discograms.
One of my pain management providers disagrees, and states we should only use 01935/01936 for any spinal procedures.
Any guidance would be greatly appreciated.
Thank you!


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## aaron.lucas (Jun 3, 2013)

Your provider is incorrect, 01991-01992 descriptions specifically state they are for injections, and therefore are the only anesthesia codes that should be used for epidurals and facets.  You are correct in your use of 01935/36 however for RFA, discograms etc.  There is an ASA crosswalk, but based on CPT guidelines and how anesthesia codes should be selected it is incorrect with regards to facet injections.  Hope this helps!


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## dwaldman (Jun 3, 2013)

Aaron, wouldn't you say since facet block state that image guidance is required and included in the procedure that 01936 would used for facet joint injection. Whereas, 01992 would be reserved for an epidural which can be performed with or without image guidance.


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## aaron.lucas (Jun 5, 2013)

From what I understand about the guidelines, and how to select anesthesia codes, it's supposed to be based on the primary procedure.  For facet blocks the primary procedure is the injection code, the guidance is just a "supporting" procedure, so the anesthesia code would have to correspond to the injection, hence the 01991/01992, because these are specifically for "...nerve blocks and injections", whereas the other codes are less specific.  That's the other reason I feel 01935/01936 aren't really appropriate hear, there are other more specific codes that match.  Not sure why ASA thinks the other codes should be used, maybe for the reason you state, but that goes against how the anesthesia codes are supposed to be selected.  I would also say that just because fluoro is required and included in the injection code shouldn't influence the code selection, because if the patient is not prone and 01935/36 is used, that's two additional units of anesthesia compared to 01991.  Does anybody have in writing the AMA guidelines for anesthesia code selection?  They're not in the book itself.


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## beatet66 (Jun 5, 2013)

Shouldn't 01935/01936 be used for the simple fact that facets as well as TFESI injections are percutaneous spinal procedures?


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## aaron.lucas (Jun 5, 2013)

They are, but so is an interlaminar epidural.  The point I was trying to make is they are all nerve blocks/injections, and there is a more specific anesthesia code that corresponds to those types of procedures.  Does that make more sense?


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