Anesthesia Coding Alert

Pay attention to laterality and other factors.

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.

Remember these points when coding for post-op pain management by your anesthesiologist:

• When postoperative pain management services are performed bilaterally, report the unilateral code once with modifier 50 (Bilateral procedure). Use the applicable base value for the unilateral code.
• A bilateral pain management code may be considered as one surgical service and may be eligible for reimbursement equal to 150 percent of the maximum allowance for the code. Verify with your insurer whether this is the case.
• 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.
• Only report 01996 for epidural or subarachnoid administration. According to CPT^® Assistant guidelines, “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.”