Anesthesia Coding Alert

LCDs and other resources to help you determine when 01996 is legit.

The descriptor for 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) seems simple enough on the surface, but can get

complicated in real-life coding. Read on for three scenarios from the Coding 911 listserv and our experts' answers on how to handle each situation.

Global Periods Help Steer Your 01996 Usage

Scenario 1: Our physician recently inserted an intrathecal pump, which is a three-day inpatient stay. We code the implant on the first day, but need to use a code for daily management of the intrathecal pump on the second and third days. We used to report 01996, but recently started having problems getting it paid. Medicare also says 01996 is inclusive to the stay. How do we handle this? (Submitted by Karen Went, Connecticut Paincare)

Solution: Start by verifying the global period for the service you're potentially coding. Code 62350 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy) has a 10-day global period. "If the pain management specialist is performing 62350, then all services related to the catheter in the 10-day period following are included in the initial fee," says Diane Crosthwaite, CPC, CANPC, coding manager for abeo, Inc., Western Division, in Pasadena, Cal.

Watch LCDs for State-Specific Directions

Scenario 2: The physician sees a patient on the hospital floor and provides epidural catheter placement and management on separate days. The documentation is a limited handwritten progress note in the chart. The coder must determine whether the note is adequate documentation and needs suggestions on how to talk with the physician about better documentation in the future. (Submitted by a Massachusetts subscriber)

Solution: "Check the LCD for 01996 in your state," advises Crosthwaite. "The documentation requirements should be listed there, and you can forward that to your physician since they often want to see things in writing."

Tip: If your state doesn't have an LCD for 01996, check other areas. For example, Massachusetts doesn't have an LCD for 01996. National Government Services, Inc., in Indiana, however, does. The policy outlines appropriate diagnoses associated with 01996 when reporting epidural or intrathecal injections for acute post-operative pain management or for intrathecal Baclofen administration. Additional notes offer guidance for using specific diagnoses correctly.

Check for Services on Removal 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 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components ...) because no bolus is given, but the documentation doesn't meet the E/M requirements. (Submitted by a California subscriber)

Solution: 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.