Anesthesia Coding Alert

Question: Is it appropriate to bill Medicaid for anesthesia during intralesional injections? We report the appropriate anesthesia code and diagnosis 701.4, but the carrier denies it.

Washington Subscriber

Answer: Your first challenge is proving medical necessity for anesthesia during the procedure, especially because your diagnosis of 701.4 (Keloid scar) probably doesn't support its need. Review the documentation for any other medical reasons that justify anesthesia (patient status, comorbidity diseases, etc.), then link these diagnoses and any appropriate HCPCS codes to support the service.

Once you've established medical necessity, surgical codes 11900 (Injection, intralesional; up to and including seven lesions) or 11901 (... more than seven lesions) apply, depending on how many lesions the physician treats. These cross to the three-unit anesthesia code 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified).