Anesthesia Coding Alert

Question: If our anesthesiologist places an epidural catheter for a patient's labor, we only charge one time. If the anesthesiologist places an epidural for pain management and checks on the patient later that same day, we don't charge -- but if he sees the patient again the next day, we do bill the service. Our physicians are questioning whether this is correct protocol. Can you verify what we should be doing?

West Virginia Subscriber

Answer: The correct way to handle the situation depends on the circumstances.

Option 1: If the anesthesiologist uses the same catheter for the pain management epidural that he used to administer anesthesia during the procedure, you cannot bill the epidural for that day. You can, however, report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) for pain management services associated with the epidural the next day.

Option 2: If the anesthesiologist places the epidural exclusively for pain management and the same catheter isn't used for anesthesia administration, you can bill the epidural separately. Report 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]). Be sure to append modifier 59 (Distinct procedural service) to indicate the epidural is separate from the procedural anesthesia. You can also report 01996 for follow-up pain management service.

Option 3: If the anesthesiologist places the epidural for the patient's labor, you'll handle the situation differently. Bill the service based on time with 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 an epidural catheter during labor]) or 01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]), as appropriate.