Perspective on Manipulation Under Anesthesia: Q&A With Dr. Robert Goldstein of Somnia Anesthesia Services

Q: What is the current national perspective on manipulation under anesthesia and how does it pertain to ASCs?Robert Goldstein, MD, executive vice president and chief medical officer, Somnia Anesthesia Services: Manipulation under anesthesia remains a very controversial procedure, with variable results and disagreements among insurers on whether it is a covered benefit. Because the procedure requires minimal support staff, no durable or disposable medical equipment/supply costs and is of short duration, we saw them primarily done in ASCs looking for proceduralists to utilize their operating rooms.  Chiropractors are the most common proceduralists performing MUA. Occasionally orthopedic surgeons do them to confirm the extent of a patient’s injury prior to surgical incision but not ordinarily as an independent procedure. The literature is ambiguous about efficacy and demand has seemed to wane in recent years.

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Somnia’s affiliates do not currently provide anesthesia for MUA in any of their facilities.

Hank Weiss, Somnia’s director of billing and pain management, has added that there is no specific billing code that links for MUA. The manipulation is procedure code 98940, and we would have to link that code to anesthesia code 00640 (three base units) with a -23 modifier. The chiropractor may have to write a letter of medical necessity as to why the anesthesia services were needed, as it is difficult to get these claims reimbursed. Mr. Weiss said that in most cases the chiropractor will probably pay the anesthesiologist a flat fee (out of pocket) to do the procedure.

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