Anesthesia Coding Alert

Question:  If a facet block is done under MAC (monitored anesthesia care) anesthesia would both the surgeon (pain management physician) and the anesthesia group bill 64493? Or would the anesthesia group bill 01936 along with the anesthesia time and the surgeon would bill 64493? 

West Virginia Subscriber

Answer: The surgeon will report 64493 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], lumbar or sacral; single level) and the applicable codes for any supplies used for the injection.

If you’re coding for anesthesia, you need to report anesthesia codes instead of surgical codes. You may have noticed, however, that the crosswalk for the surgical code indicates “***ANESTHESIA CARE NOT TYPICALLY REQUIRED***”.  This is because the American Society of Anesthesiologists (ASA) publishes a Statement on Anesthetic Care During Interventional Pain Procedures for Adults that indicates adults undergoing minor pain procedures do not require anesthesia care – unless there are co-morbidities or conditions dictating the need for anesthesia. If the patient is a child or there is documented medical necessity, the most appropriate anesthesia code choices are 01991 (Anesthesia for diagnostic or therapeutic nerve blocks and injections (when block or injection is performed by a different physician or other qualified health care professional); other than the prone position) and 01992 (… prone position), depending upon the patient’s position during the procedure.