# Epirdural steroid injection



## Lisa Heikes (Mar 9, 2009)

I am fairly new to coding for a CRNA and am wodering how to correctly report the code for epidural steroid inejctions would I use the anesthesia code 01991 or the surgery code 64480, 62311.  The CRNA works without medical direction from an MD. Thanks.


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## jdrueppel (Mar 9, 2009)

If the epidural steroid injection is being performed by the CRNA this is a surgical procedure and would be billed using the surgical CPT code.  Use of an anesthesia CPT code (your example: 01991) is only appropriate when you are billing for an anesthesia service.

Hope this helps.

Julie, CPC


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## roz65 (Apr 21, 2011)

*asa code for cpt code 62311*

when an Anesthesiologist administers anesthesia for an epidural injection(62311) in the prone position, can the asa code 01992 still be assigned to this procedure? Note, as of Jan 1, 2011, no asa code was assigned in the cross-walk. Please be advised that this is not the same Provider performing the procedure. Or should i simply use 64483 with asa code 01936?


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## dwaldman (Apr 21, 2011)

No, although 01992 and 01991 are column two codes but 01936 might not be listed as column two code, as it is stated in the CCI policy manual, correct coding is still required in absent of CCI edits. The edit is that the physician performing for example a epidural injection can not also report the anesthesia code for providing for example MAC for the injection. 
G. Anesthesia Service Included in the Surgical Procedure


Under the CMS Anesthesia Rules, with limited exceptions, Medicare does not allow separate payment for anesthesia services performed by the physician who also furnishes the medical or surgical service. In this case, payment for the anesthesia service is included in the payment for the medical or surgical procedure. For example, separate payment is not allowed for the physician's performance of local, regional, or most other anesthesia including nerve blocks if the physician also performs the medical or surgical procedure. However, Medicare allows separate reporting for moderate conscious sedation services (CPT codes 99143-99145) when provided by same physician performing a medical or surgical procedure except for those procedures listed in Appendix G of the CPT Manual.


CPT codes describing anesthesia services (00100-01999) or services that are bundled into anesthesia should not be reported in addition to the surgical or medical procedure requiring the anesthesia services if performed by the same physician. Examples of improperly reported services that are bundled into the anesthesia service when anesthesia is provided by the physician performing the medical or surgical procedure include introduction of needle or intracatheter into a vein (CPT code 36000), venipuncture (CPT code 36410), intravenous infusion/injection (CPT codes 96360-96368, 96374-96376) or cardiac assessment (e.g., CPT codes 93000-93010, 93040-93042). However, if these services are not related to the delivery of an anesthetic agent, or are not an inherent component of the procedure or global service, they may be reported separately.


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## dwaldman (Apr 26, 2011)

Roz65, 
I  previously responded without reading your question carefully enough. Sounds like you are stating an anesthesiologist provided MAC or general anesthesia for patient having epidural with possible anxiety or other circumstances requiring this level of sedation.  You would be able to report 01992 for this situation. I was just pointing out the reason the codes are bundled are for if physician performing the procedure (62311) can not also bill 01992.


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## hgolfos (Apr 26, 2011)

roz65,
Yes, you can still use the 01991 and 01992 codes to report anesthesia services for an epidural even though the new crosswalk states "anesthesia care usually not required" just be sure that you have a documented medical reason for the anesthesia, such as the anxiety dwaldman mentioned.  I would recommend hanging on to your 2010 crosswalk as there are several codes that have had their crossovers deleted this year.

Hope this helps


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