Anesthesia Coding Alert

Question: When an anesthesia provider inserts an epidural catheter for post-op pain management, I know the first day of hospital daily management is included in the catheter insertion, but what about subsequent days?

Utah Subscriber

Answer: Coding for daily pain management changed significantly this year when CPT 2003 added restrictions to the existing code for this service (01996, Daily hospital management of epidural or subarachnoid continuous drug administration). The new parenthetical note with the code explains, "Report code 01996 for daily hospital management of continuous epidural or subarachnoid drug administration performed after insertion of an epidural or subarachnoid catheter placed primarily for anesthesia administration during an operative session, but retained for postoperative pain management."
 
Many coders have been confused by various interpretations of this note. If you report services based strictly on this note, you only report 01996 for subsequent days of pain management when the epidural was placed primarily for anesthesia during the procedure.
 
If the physician placed the epidural to use only as post-op pain relief, bill the catheter placement with either 62318 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62319 (... lumbar, sacral [caudal]). For the daily management, report E/M code 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem-focused interval history, a problem-focused examination, medical decision making that is straightforward or of low complexity).
 
Ask your local carrier how to report these services. Some carriers accepted this new guideline for reporting follow-up pain management, but others still ask you to report 01996 for follow-up care regardless.