Anesthesia Coding Alert

Question: Our provider administered anesthesia for a patient having a myelogram. What is the best code to report? If I submit 01999, what procedure should I map it to?

Pennsylvania Subscriber

Answer: Begin your code selection by verifying the spinal area that was treated. Then, based on that information, report either 01937 (Anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic) or 01938 (… lumbar or sacral).

Because these two codes are appropriate options, there is no need to report 01999 (Unlisted anesthesia procedure(s)).

Also note: Administering anesthesia during a myelogram normally is not a problem from an insurance perspective when a child is being treated. However, if the patient is an adult, coding guidelines state that anesthesia care is not typically required. You should still be able to acquire reimbursement with thorough documentation of medical necessity. As the Anesthesia Crosswalk states, “Although anesthesia care is not typically required, coverage/payment should not be routinely denied when medically necessary.”