General anesthesia with epidurals

Are lumbar and cervical epidurals always administered under general anesthesia?  What is the typical way this is done in the pain management community?  Does anyone get the epidurals without general anesthesia?  

I have always had them done with general anesthesia, but now the insurance company says that it will not pay for two anesthesia services performed on the same day by two different providers.  They regard the epidural itself as anesthesia.  

On the other hand, they say they would pay for the two services if they were performed by the same provider.  How could the surgeon perform the epidural procedure and administer general anesthesia at the same time?  That's preposterous.

Has anyone ever had the same physician perform both the epidural and the general anesthesia?  

Does anyone have any ideas or suggestions about this?

[peekawho]

I've had it done both ways.  The first PM guy I went to did the epidural steroid iinjections with only local anesthesia,  It was only slightly uncomfortable, very quick.  He did it in his office, under xray guidance.  I had 6 last year.

The pM guy I have now uses a light form of general anesthesia.  The procedure only takes 5 minutes, and with this guy, is done in a surgical center.  You are only asleep for minutes.  The anesthesia is performed by either an anesthesiologist, or a nurse anesthetist. You wake up and go right home, of course someone has to pick you up from the facility.   Your PM provider performes the epidural steroid injection.

Your insurance company is confused.  The "epidural" you speak of is not EPIDURAL ANESTHESIA.  It is called an EPIDURAL STEROID INJECTION.  It is NOT anesthesia.   You need to speak with a supervisor, and let them know they are mistaken.  They are confused about the terminology.  

Your PM provider should be handling all this, anyway.  Typically, THEY contact your insurance, ascertain your benefits, and make the arrangements.  If there is a stumbling block, your PM provider staff will let you know.  

[monsterjam2]

My cervical epidural was not done under general anesthesia.  I was given Valium prior to the procedure.  It's really not that bad.  Probably not a good idea to have the person doing the procedure monitoring how you are breathing, though!  Sounds like the insurance company doesn't have a clear vision of the procedure, perhaps they have the wrong code.  Best of luck!

[squirtatious]

My first two, I was not given anything but a local to numb the site of the injection. My last one I was given something to relax me. Never had I been completely put under. Didn't even know that WAS an option.

[squirtatious]

Technically speaking, an epidural IS a form of anesthesia.

[coach4646]

1. was it painful or just a normal stick w/ pressure as fluid is injected?
2. How long did it last?
3. What drug combo did your PM DR. use?

[coach4646]

1. did the PM Dr. epidural hurt or was it the normal stick w/ pressure when injection is happening.
2. How long did it last for, I have had a fusion/lumbar and have pain and only want to do of it will last for several months b/c i dont want to take the drugs.
3. What combo of drugs did your PM Dr use?
I THANK YOU SO MUCH FOR YOUR POSTING AND CANT WAIT TO HEAR BACK B.C IM TRULY CONCERNED OF SIDE EFFECTS AND DID YOU HAVE ANY NERVE PROBLEMS AFTERWARD? THANKS -D

[atonicat]

It does not hurt at all. The thing that hurts the most is when they stick you with lidocain to numb you up. The actual injection does not hurt.

Mine lasted about a month. I had 3 sets of injections at four different levels, so 12 actual injections.

My doctor used a steroid and fentanyl in the same injection so even after it was done I wasn't in pain because of the fentanyl.

[SLCPMOM]

Dear SueBelleMae,
General anesthesia is when you are completely under.  (Like when you have major surgery).  There is always an anesthesiologist present to monitor heart rate, O2 stats and EKG.  General anesthesia is not a covered service for an epidural steroid injection because it is not medically necessary since these procedures usually take less than 10 minutes.  Moderate sedation is what is usually given during procedures.  It is generally referred to as Twilight sedation.

[atonicat]

I had no sedation during all of mine. I didn't have the need for it. It's seriously and in and out thing. I had sedation when I had radio frequency ablation (nerve burns) because it takes longer and is a lot more uncomfortable.