Anesthesia Coding Alert

Question: What would the anesthesia code be if the physician administered total intravenous anesthesia for left L3-4, L4-5, L5-6 transforaminal epidural steroid injections (TF ESI)?

New York Subscriber

Answer: Total intravenous anesthesia (TIVA) is a technique of anesthesia which involves the use of intravenous drugs to anesthetize the patient without the use of inhalational agents. In 2016, the base CPT^® code for TIVA for a transforaminal epidural steroid injection (ESI) is 64483 (Injection[s], anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance [fluoroscopy or CT]; lumbar or sacral, single level). Report 64484 (…lumbar or sacral, each additional level [List separately in addition to code for primary procedure]) for additional levels. Remember that both of these codes include imaging guidance, so no additional code for fluoroscopy is needed.

Take note: This is a code change from previous years, when you reported TIVA in these situations with 62311 (Injection[s], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]).  

Also: The American Society of Anesthesiologists (ASA) does not recommend anesthesia for these kinds of pain management procedures. If the patient is a child or has other special circumstances, you might be able to justify separate anesthesia.