Anesthesia Coding Alert

Question: Our physician placed an epidural as part of the anesthesia technique along with the use of general anesthesia. The anesthesiologist says using both allowed for less use of the general anesthetic, which let the patient awaken more quickly and with fewer side effects. He left the epidural in place after the procedure for postoperative pain management. We will bill the service as a general anesthesia case. Can we bill for the epidural placement and daily epidural management? Nevada Subscriber Answer: The short answer is: It depends on your physician's documentation. Best case: If your anesthesiologist places the epidural for postoperative pain relief, you can often bill the epidural on the same day as the anesthesia services. You would report 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]), depending on the epidural's location. You would also append modifier 59 (Distinct procedural service) to show that the epidural is separate from the surgical anesthesia. Caution: Your question states that your physician also used the epidural "as part of the anesthesia technique." This changes the scope of his service and makes the epidural not separately billable because it's considered part of the anesthesia service. Follow-up care: The anesthesia code includes any follow-up care your physician provides on the day of surgery. You can report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) for additional days.