# Epidural Steroid Injection by CRNA/MD



## pylesjl (Sep 17, 2007)

Is there any instance where a CRNA or MD can bill an ESI under anesthesia codes?  I have them billing under 00635 and/or 01991 when they actually performed the ESI in an outpatient setting.  And, the anesthesia codes are being billed with minutes.

I appreciate any help.  You can e-mail me at jpyles@phsystems.com.

Thanks.


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## susanlwright (Nov 7, 2007)

Do you mean that the ESI is in addition to anesthesia for a procedure?  If this is the case and the ESI is for postop pain, then the code for the ESI should be either 62310 or 62311.


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## pylesjl (Nov 15, 2007)

There is no additional anesthesia.  Only the epidural was performed.


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## 1071471 (Nov 16, 2007)

*Epidural Steroid Injections*

You would bill 62310-cervical or 62311-lumbar.  They are usually not done under anesthesia.  Hope this helps.


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## NIENAJADLY (Jun 20, 2008)

*Epidural under anesthesia*

You can bill for anesthesia for the epidural IF another, non-group-related physician is doing the epidural.  We, for example, would use 62311 for the CPT to cross over to the 01992 ASA.  Certain carriers won't pay for it as not medically necessary but we don't see it that often so it's hard to tell.


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## Dorothy Godolphin (Jul 2, 2008)

*ESI by CRNA*

Sounds like this was the type of anesthesia being used for the procedure, not sure?   But the one thing I saw was the 01991 * that is for a patient in the supine position* ...if the CRNA was providing anesthesia for an epidural then you would need to bill 01992 (prone position) for his anesthesia code but if he was truly performing an ESI injection for pain good luck getting it paid. Most carriers won't pay us for CRNA who perform ESI for pain mgnt.
Hope this helps
Dottie G


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## Codingabc123 (Jul 2, 2008)

We have a pain management doctor who does ESI's with a CRNA providing MAC under medical direction of another doctor in the same group practice.  Payment for the anesthesia is hit or miss under these circumstances.  A CRNA not under direction has not previously been paid.  We typically do not have CRNAs providing ESI injections.  Hope that helps.


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## Dorothy Godolphin (Jul 2, 2008)

*ESI and CRNAs*

Another thing when billing for anesthesia by another provider in the same group ....if you are billing to a carrier that you are paid under one group#...the carrier will argue this is bundled because they are paying for the provider in your group that has done the block.  So they see this as unbundling.  We get our CRNAs paid even if they are not medically directed by some carriers.  When our Administrator is negiogating contracts he explains that we also have pain centers that are doing these blocks and providing anesthesia for some of the patients.  Think this helps to some degree.
Thanks
Dottie


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## skincer (Aug 13, 2008)

*ESI by CRNA*

Can you bill the ESI (62310-62311) in addition to the CRNA (01992)? The provider giving the injection is the anesthesiologist and does not supervise the CRNA and we append modifier QZ to CRNA charge. 

In addition, we have different providers who may give the injection and the anesthesiologist supervises CRNA and we submit 3 claims...one for the provider giving injection, one for the supervising anesthesiolgist with QY modifier and CRNA claim with QX modifier.

Are these scenarios typical and adhering to correct coding initiatives? We've read conflicting data from several sources and interested in your opinion.

Thanks in advance!!!
DV, CPC


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