Wisconsin Physician Services (WPS) – Medicare – coding guidance for facet joint interventions and epidural steroid injections for pain management has updated their policies to reflect that use of moderate/deep sedation, general anesthesia and monitored anesthesia care (MAC) is usually unnecessary or rarely indicated for these procedures. Payment may be considered on appeal for exceptional circumstances if the medical necessity of sedation is unequivocal and clearly documented by the provider in the medical record. The update for these policies goes into effect December 2022.

Monitor your anesthesia cases for the following:

• 01937 – anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; cervical or thoracic
• 01938 – anesthesia for percutaneous image-guided injection, drainage or aspiration procedures on the spine or spinal cord; lumbar or sacral

Just like Medicare, commercial payers may have their own version of an Advanced Beneficiary Notice (ABN) or waiver that must be completed and signed by the patient prior to the delivery of the service.

ACE Expert 
Susan West, RHIT
aceadmin@aceauditors.com