OIG: Improper Payments for Anesthesia in Spine Procedures

A report from the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) estimated that Medicare could have saved approximately $17.7 million in improper payments for anesthesia services provided during spinal pain management procedures.

The OIG found that anesthesia was billed in 18% of 3.9 million sessions, with fewer than 1% of those claims denied by Medicare Administrative Contractors (MACs). In a small sample review, 20 out of 28 claims lacked documentation of a “rare circumstance” in which administering anesthesia would be reasonable or necessary.

The OIG made recommendations to CMS to avoid improper payments. More information can be found here.

• Our Coding & Reimbursement FAQs for Interventional Pain Medicine Procedures page breaks down scenarios by procedure and provides clarity on coding for follow-ups and multiple same-day procedures and consultations.
  
  
• The IPSIS Open Forum is a channel where members frequently discuss thorny coding issues. Look up the threads there on your situation or start your own discussions.
  
  
• Still stumped? If your question is not currently addressed or if you have a follow-up question, click here 🔒 to submit your question and receive expert coding advice.

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