Anesthesia Coding Alert

Question: Our anesthesiologist administered spinal anesthesia during a patient's hip replacement surgery, and then used an epidural for postoperative pain management. Can we bill for both services? If so, what code should I report for the epidural?

Texas Subscriber Answer: If your physician used separate catheters for the surgical anesthesia and the epidural, you can report both services. Submit 01214 (Anesthesia for open procedures involving hip joint; total hip arthroplasty) for anesthesia during the hip surgery.

Code the epidural according to whether he administered an injection or placed a catheter, and the epidural's placement. Your choices include 62310-62319. 

Physicians normally use the lumbar site for these epidurals, which leads you to 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 a single injection.

Report 62319 (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; lumbar, sacral [caudal]) for continuous infusion.

Cervical option: If your physician administers the epidural in the cervical region, report 62310 (... cervical or thoracic) for a single injection or 62318 (... cervical or thoracic) for continuous infusion.

Add the modifier: Once you determine the correct epidural code, append modifier 59 (Distinct procedural service) to show that the postoperative pain management was separate from the surgical anesthesia. Include an appropriate postoperative pain diagnosis such as 338.x (Pain, not elsewhere classified).