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Anesthesia Coding Alert

Reader Question:

Focus on Reason for Procedure When Choosing a Diagnosis

Question: Should the ICD-9 placed on the 1500 claim form be related to the procedure itself or the medical reason for requiring MAC? Rhode Island Subscriber Answer: The diagnoses given on the CMS 1500 claim form should always support the necessity of the procedure performed instead of being related to the anesthesia given (whether it’s MAC, general, etc.). Example: A patient comes to the physician complaining of low back pain (724.2). After examination, the physician decides to perform a lumbar epidural injection. He gives an anesthetic at the site of the injection and then administers an anesthetic and/or steroid injection for pain management. The coder should report CPT® 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]) and ICD 9 code 724.2 on [...]

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