Monday, July 19, 2010

Aetna - Payment policy of monitored anesthesia care

Billing anesthesia for pain management services under Aetna

Aetna says that it will not pay for monitored anesthesia care with the following pain management codes:


 Code    Description  
 20526    lnjection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel  
 20550    lnjection(s); single tendon sheath or ligament, aponeurosis (e.g., plantar "fascia")  
 20551    lnjection(s); single tendon origin/insertion  
 20552'    Injection(s); single or multiple trigger point(s), one or two muscle(s)  
 20553"    Injection(s); single or multiple trigger point@), three or more muscle(s)  
 20600    Arthrocentesis, aspiration andlor injection; small joint on bursa (e.g., fingers, toes)  
 20605    Arthrocentesis, intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)  
 20610    Arlhrocentesis, major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)  
 27096    Injection procedure for sacroiliac joint, arthrography andlor anestheticlsteroid  
 62263    Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days  
 62264    Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day  
 62270    Spinal puncture, lumbar, diagnostic  
 62273    Injection, epidural, of blood or clot patch  
 62280 62281    Injectionlinfusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid lnjectionlinfusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic  
 62282    lnjectionlinfusion of neurolytic substance (eg., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)  
 62310' 6231 1'    Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)  
 62318'    Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic  

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