Article Detail - JF Part B
Inappropriate Anesthesia Services Billed During Spinal Pain Procedures
The Office of Inspector General (OIG) recently reported that Medicare Part B paid physicians approximately $45.7 million for anesthesia services during certain spinal pain management procedures that may not have met Medicare requirements (OIG report A-09-23-03013).
The nationwide audit revealed that these payments were associated with anesthesia administered during selected spinal pain management procedures that posed a risk of noncompliance with Medicare requirements.
In light of these findings, Noridian is reminding physicians to review the anesthesia limitations for spinal pain management procedures outlined in the three Noridian Local Coverage Determinations (LCDs).
- LCD L39240 - Epidural Steroid Injections for Pain Management, the limitations section instructs:
"Use of Moderate or Deep Sedation, General Anesthesia, and Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for these procedures and therefore not considered medically reasonable and necessary. Even in patients with a needle phobia and anxiety, typically oral anxiolytics suffice". - LCD L38803 - Facet Joint Interventions for Pain Management, the limitations section instructs:
"Use of Moderate or Deep Sedation, General Anesthesia, and Monitored Anesthesia Care (MAC) is not considered medically reasonable and necessary during facet injections. Routine use of Moderate Sedation or Monitored Anesthesia Care (MAC) or use of General Anesthesia or Deep Sedation for radiofrequency ablation (RFA) is not considered reasonable and necessary". - LCD L39464 - Sacroiliac Joint Injections (SIJ) and Procedures, the limitations section instructs:
"Use of Moderate or Deep Sedation, General Anesthesia, or Monitored Anesthesia Care (MAC) is usually unnecessary or rarely indicated for SIJ injections and therefore, not considered medically reasonable and necessary. Even in patients with a needle phobia and anxiety, typically oral anxiolytics suffice".
It would be considered exceptional and unique for a patient to require anesthesia for these services, and the documentation in the medical record must support the need for such sedation for the specific patient, the specific service, and the specific encounter.
