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Should anesthesia be requested before or while administering pain medication injection?

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Addiction Medicine Specialist
Practicing since : 1985
Answered : 2798 Questions
Question
When a provider is administering injections to the lower back for pain blockage, and the patient is requesting anesthesia for the service can the service be requested as a prior authorization or coverage determination? If so how would the doctor request the service? Would the provider just request anesthesia at a ASC and say low back surgery or what?
Wed, 25 Apr 2018 in Pain Management
 
 
Answered by Dr. Matt Wachsman 55 minutes later
Brief Answer:
It is not often done.

Detailed Answer:
This is getting general anaesthesia (being put under) for getting a spinal injection? I've literally never heard of this being done. It's not going to happen:


1) it increases the risk of the procedure so much that there is basically ONLY the risk from the anaesthesia, not from the injection.
2) it increases the time and cost of the procedure so much so that basically, it is a general anesthetic procedure with the actual injection being a minor addition to it. The scheduling would be around the anesthesiologist. the time would be for the general anesthesia and the injection would be hardly any time at all. The cost would be a LOT with renting the space, getting the anesthesiologist AND the anesthesiologist nurse, the multiple drugs involved, the recovery area and personnel, and probably more than that.
3) there would be other options. Taking a xanax for example.

It isn't going to happen. There is an authorization number. It takes much longer than the injection to get an authorization. The insurance will not approve it and will suggest several other alternatives.
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Follow-up: Should anesthesia be requested before or while administering pain medication injection? 14 minutes later
Just making sure, not even Medicare will approve?

Thank you so much for you response!
 
 
Answered by Dr. Matt Wachsman 17 minutes later
Brief Answer:
unlikely...

Detailed Answer:
Ok, first, even Medicare is often/usually not medicare. Components of it are handled by other companies (drug benefits especially). So this would be the same (sorry) hard-assed commercial insurance companies that deny coverage for everything else.

And, Medicare is a large company. It can only function by being very unimaginative. It has coded lists of procedures, what they are for, what happens during them, and what monies flow where from them. This is not in the usual framework. They Will Freak. Not only won't they pay, they might not be able to even have the conversation about this. The usual pre-authorization channels for Medicare might not have the ability to deal with a procedure that is not generally done and it might not be possible for them to discuss it. Then, they'd deny it.
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