Anesthesia Coding Alert

Question: How should I code for lumbar pain epidurals administered by an unsupervised certified registered nurse anesthetist (CRNA) in an ambulatory surgery center (ASC)? The primary crosswalk code for epidural codes 62310 and 62311 is 01961 (Anesthesia for cesarean delivery only). Ohio Medicare only recognizes 01961 for a c-section even with a diagnosis of lumbar pain or neuropathy.

Ohio Subscriber

Answer: If your state allows the CRNAto administer the block, then you should bill it exactly as if the anesthesiologist had performed the block with surgical instead of anesthesia codes. Appropriate epidural codes will depend on whether it was a single injection or catheter administration. Use 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]) for single-shot administration.                                                                                      

Use 62318 (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; cervical or thoracic) or 62319 ( lumbar, sacral [caudal]) for catheter infusion. If the carrier requires an anesthesia code, consider 00635 (Anesthesia for procedures in lumbar region; diagnostic or therapeutic lumbar puncture).