Advanced Search

Anesthesia Coding Alert

You Be the Coder:

MAC for LESI

Published on Sat Dec 01, 2001

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.

Question: I am having difficulty getting paid for MAC anesthesia with lumbar epidural steroid injections (LESI). Carriers do not recognize 00640 because it is not in CPT-4. I bill 00630-52 for reduced services, but the claims are denied for lack of  medical necessity.

Louisiana Subscriber
 
 
 
 
 
 
 
Answer: ASA code 00640 (anesthesia for closed procedure on cervical, thoracic or lumbar spine), as well as proposed code 01905 (anesthesia for myelography, diskography, vertebroplasty), is not yet recognized by most carriers. Therefore, it may be appropriate to use 00300 (anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified), which carries a base value of five units plus time units. Using 00630 (anesthesia for procedures in lumber region; not otherwise specified) with modifier -52 (reduced services) probably confuses carriers because it makes them decide how many base units to pay. In 2002, you may be able to use 01905 for these cases, as it has been approved by CMS and appears in CPT Codes 2002.
 
More important than coding, however, is the need to document the medical necessity for providing MAC with the procedure. If the carrier determines that MAC for this epidural injection is not medically necessary (and many will), patients can choose to pay for this service. Have them sign an advance beneficiary notice to ensure payment.

Other Articles in this issue of

Anesthesia Coding Alert

View All