Anesthesia Coding Alert

Question: One of our pain management specialists administered a facet block under MAC (monitored anesthesia care) anesthesia. The anesthesiologist administering MAC is also part of our physician group. Do we bill 64493 for each of them? Or do we bill an anesthesia code and time for the MAC and 64493 for the pain management physician?Virginia Subscriber

Answer: The physician who administered the block 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 any applicable codes for supplies used for the injection.

The provider who administered MAC should report an anesthesia code instead of a surgical code.

You may have noticed, however, that the anesthesia crosswalk for 64493 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.

Plus: Don’t forget to add the QS modifier (Monitored anesthesia care service) to identify MAC if required by the insurer.