Anesthesia Coding Alert

Let these 3 scenarios guide when you code for daily hospital management.

The anesthesia codes you commonly report normally include many services, such as pre-op work and all anesthesia care until the patient is released to post-op recovery. When the anesthesiologist is asked to also provide postoperative pain management, questions can arise regarding when you can – or should – report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). Let the following scenarios guide your decision the next time you’re faced with the situation.

Submit 01996 for Additional Days Following Epidural Block

Scenario 1: The anesthesiologist inserts a lumbar epidural catheter to manage post-op pain following a total knee replacement procedure. He connected the catheter in the post-anesthesia care unit (PACU) to medication as a continuous infusion. Can you bill for this separately? Also, how do you handle coding when the anesthesiologist visits the patient the next day to see how the continuous epidural is working?

Solution 1: If the anesthesiologist did not use the epidural catheter as a means of anesthesia for the surgery, then you can use 62319 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral [caudal]), to report the epidural catheter placement. Because the anesthesiologist administered the block on the same day as surgery, make sure to append modifier 59 (Distinct procedural service) to 62319. This communicates to the payer that your provider performed the epidural procedure for post-operative pain management only and not as a means of anesthesia for the total knee replacement.

Same-day visits by your anesthesiologist after post-operative placement of the epidural catheter are not separately billable. However, if your provider needs to see the patient on subsequent days to manage the continuous pain management infusion, then as directed by the CPT® parenthetical note, “Report 01996 for daily hospital management of continuous epidural or subarachnoid drug administration performed after insertion of an epidural or subarachnoid catheter.” Submit 01996 once per day as it includes all E/M services associated with the continuous infusion management regardless of how many times the doctor saw the patient.

Don’t File 01996 After Single-shot Morphine Administration Scenario 2:

The anesthesiologist provided an epidural to an OB patient for cesarean section. She used a specific brand-name preservative-free morphine. Should you submit 01996 for using the drug during the procedure?

Solution 2: You would not report 01996 in this situation because preservativefree morphines, such as Duramorph or Astramorph, are administered with a single application. So even though it is administered through the catheter, it is not administered continually as the code descriptor for 01996 indicates.

A preservative-free morphine, such as Duramorph, is often given spinally or by epidural for C-section pain or for large episiotomy repair. Physicians often mix Duramorph with the drugs given spinally for a cesarean section. If your anesthesiologist uses this technique, he might list “spinal morphine” on the anesthesia record with other medications administered spinally.

Don’t miss: The patient should have respiratory monitoring after morphine administration due to the risk of respiratory distress. Because of this, separately report 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). If your physician gave preservative-free morphine and subsequently managed the patient’s post-op pain, you would then be able to bill 99231 on the first day of post-op care.

Remember: When you code this type of case, the original anesthetic includes the patient’s first day of postoperative pain management -- that is, the code you reported for the labor and delivery, such as 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of epidural catheter during labor]) and +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]). Any use of 01996 would begin the following day.

Let Documentation Guide 01996 Usage on Last Management Day

Scenario 3: When is it appropriate to bill 01996 for the last day of management and catheter removal? We’re divided between using 01996 or 99231 because no bolus is given, but the documentation doesn’t meet the E/M requirements.

Solution 3: Billing 01996 on the day of catheter removal depends on whether the physician provides any other services for the patient that day. If the physician removes the catheter and doesn’t provide any other services, do not report an additional charge (catheter removal is an expected service). If your physician provides other services and makes the decision to remove the catheter the following day, you can report 01996 for the day of services but not the day of removal.