Anesthesia Coding Alert

Question: An anesthesiologist says that he bills extra for the injection of a narcotic (intrathecal) via a spinal, but I've never seen anything indicating that I can do this. I use 62311 (Injection, single [not via indwelling catheter], 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; lumbar, sacral [caudal]) for the procedure whether it's an injection of lidocaine and/or bupivacaine or a narcotic (intrathecal). There is more monitoring and follow-up with a patient who has had a morphine injection, but I think this is part of the global anesthesia fee. How should I code this?

Maine Subscriber

Answer: If this procedure is performed for pain management outside of standard anesthesia time, you could bill for it and be reimbursed. The surgeon must document the request for a pain management injection before you can expect to be paid for it. However, if the injection is performed as part of anesthesia (i.e., is the mode of anesthetic for the procedure) and is done inside anesthesia time, you should not bill separately for it. If the spinal was part of the anesthesia, some insurers may pay for the extra work involved (assuming that the anesthesiologist was responsible for the postoperative pain management during the first day) by recognizing 01996 (Daily management of epidural or subarachnoid drug administration). If you bill for the insertion of the opioid (62311), most insurers will bundle the first day of postoperative pain management to that code and will not reimburse for 01996 for the first 24 hours of the intrathecal analgesia.

  Answers to Reader Questions and You Be the Coder reviewed by Dana Goodridge, director of operations for the medical billing firm Comprehensive Medical Management in Newport, Ky.