Anesthesia Coding Alert

Question: Medicare denies our claims when we bill surgical codes for epidural steroid injections (ESIs), saying they want ASA codes instead. But the ASA codes are not in the current CPT, so which code should we use?

Nebraska Subscriber

Answer: If your physician performs the injection, you should bill the appropriate surgical CPT codes for the procedure instead of anesthesia codes such as 62310, Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic; or 62311, lumbar, sacral (caudal).

Do not bill for time (as you do for anesthesia services) since surgical codes are flat fees. Also be sure your system isn't adding the -AA modifier (Anesthesia services performed personally by anesthesiologist) to the surgical code; if it is, this could be triggering your denials because of improper coding.

Whenever a carrier denies the service, resend the claim with a letter explaining that the physician performed the injection rather than administered anesthesia; attaching a copy of the code from CPT may also help.