Anesthesia Coding Alert

Question: Some of the commercial carriers in our state deny 01996 for daily pain management. What code might they accept that would be accurate?

New Mexico Subscriber

Answer: Carriers in many states, such as Pennsylvania and California, dont reimburse for daily pain management coded with 01996 because they consider it bundled with catheter insertion or as part of the anesthesia administered for the procedure rather than postoperative pain management.

Acceptable coding alternatives also vary by state. Some carriers accept 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], epidural or subarachnoid; lumbar, sacral [caudal]) for two consecutive days and 99232 (subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: an expanded problem focused interval history, an expanded problem focused examination, medical decision making of moderate complexity) for any additional days.

Other carriers prefer codes E/M 99231-99233 (subsequent hospital care, per day, for the evaluation and management of a patient ...) for all days of pain management.