Anesthesia Coding Alert

CCI and CPT® help clarify when the code applies.

Code 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) applies when the anesthesia provider starts an additional infusion or bolus in a previously placed epidural catheter. Patients typically undergo this type of administration for a two-day intrathecal pump trial or an epidural infusion procedure.

NCCI stance: According to the National Correct Coding Initiative (NCCI) coding manual, “Management of epidural or subarachnoid drug administration (CPT® code 01996) is separately payable on dates of service subsequent to surgery but not on the date of surgery. If the only service provided is management of epidural/ subarachnoid drug administration, then an evaluation and management service should not be reported in addition to CPT® code 01996. Payment for management of epidural/subarachnoid drug administration is limited to one unit of service per postoperative day regardless of the number of visits necessary to manage the catheter per postoperative day (CPT® definition). While an anesthesiologist or non-medically directed CRNA may be able to report this service, only one payment will be made per day.”

CPT® Assistant further clarifies that you should only report 01996 for epidural or subarachnoid administration. Specifically, the guidelines explain, “Currently, there is no specific CPT® code for ‘daily’ management of the peripheral or plexus nerve catheter. It is not appropriate to report code 01996 as this is specific to epidural catheters. Carrier-specific guidelines may also apply if daily catheter management or injection is performed during the immediate postoperative period of another procedure or service.”

Tip: Ask your providers to document their daily management of the epidural in the patient’s progress notes. Having specific notes will support coding 01996 for each day.