Anesthesia Coding Alert

Question: What anesthesia code is appropriate when the patient undergoes IV sedation by an anesthesiologist prior to receiving an epidural injection by the surgeon?

Epidural injection codes 62310 and 62311 convert to anesthesia codes 00820 (Anesthesia for procedures on lower posterior abdominal wall), 02100 (Anesthesia for diagnostic or therapeutic nerve blocks and injections [when block or injection is performed by a different provider]) or 02101 (Anesthesia for diagnostic or therapeutic nerve blocks and injections patient in the prone position [when block or injection is performed by a different provider]). We have billed these anesthesia codes for the procedure but have been denied. Wisconsin Subscriber Answer: As you have found, many carriers will not accept codes 02100 or 02101 since they aren't in CPT. 00820 is a CPT code, but the carrier may not consider it an acceptable code for this situation. Part of the problem may also stem from showing medical necessity for the anesthesia. Having the surgeon's request in writing, using MAC instead of IV sedation, and filing with modifier -23 (Unusual anesthesia) may help.

Anesthesiologists often perform the ESIs themselves, in which case codes 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), 62311 ( lumbar, sacral [caudal]) or 62319 (Injection, including catheter placement, continuous infusion or intermittent bolus, 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; lumbar, sacral [caudal]) would be used instead of the anesthesia codes. If you are coding for anesthesia during the procedure instead of for the injection itself, ask the carrier which codes are preferred.

When an epidural is properly performed, the injection is between a fascial layer and the dura mater; the spinal space is avoided. Because of this, it can be considered more of a muscular procedure than a neurosurgical procedure. For MAC anesthesia during the ESI, codes 00820 or 00730 (Anesthesia for procedures on upper posterior abdominal wall) may be considered more appropriate. Other options may be 00600 (Anesthesia for procedures on cervical spine and cord; not otherwise specified) or 00630 (Anesthesia for procedures in lumbar region; not otherwise specified), depending on the carrier's preference.