December 10, 2025
Anesthesia Use for Spinal Pain Management Procedures
The use of moderate or deep sedation, general anesthesia, and Monitored Anesthesia Care (MAC) is rarely indicated for pain management procedures and, therefore, not considered reasonable and necessary.
The American Society of Anesthesiologists (ASA) provides guidelines for anesthetic care during interventional pain procedures for adults, stating that when sedation is provided during the performance of a pain management procedure, it's important that the patient can be responsive during critical portions of the procedure to report potential procedure-related paresthesia, acute changes in pain intensity or function for potential toxicity.
Twilight sedation isn't part of the ASA continuum for depth of sedation, so the specific depth of sedation, if used, must be reported in the medical record with the reason why the patient needed sedation.
Interventional pain procedures generally only require local anesthesia; however, patients may elect to also receive supplemental sedation but must remain conscious.
Even in patients with a needle phobia and anxiety can be managed with oral anxiolytics. The need to remain motionless isn't sufficient as being awake isn't a contraindication to epidural placement. Movement in the patient can occur even with anesthesia. In exceptional and unique cases, if the provider and care team determine the need for a deeper level, documentation in the patient's record should indicate why it was necessary, what alternatives were tried, what type of anesthesia was used, and the outcomes.
Billing moderate or deep sedation, general anesthesia, or MAC during a pain management procedure other than radiofrequency ablation will result in a claim denial. Frequent reporting of these services together may trigger focused medical review.
References
- American Society of Anesthesiologists, Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia
, 2019; accessed 08.12.2021 - American Society of Anesthesiologists, Statement on Anesthetic Care During Interventional Pain Procedures for Adults
, 2021; accessed 09.06.2022 - L39015 – Epidural Steroid Injections for Pain Management

- L38773 – Facet Joint Interventions for Pain Management


