Anesthesia Coding Alert

Question: Our providers have begun to administer a different type of nerve block for postoperative pain management following some knee and shoulder replacements. On saphenous/femoral nerve blocks, instead of just injecting a nerve once (64447), they are inserting a catheter as they would for a continuous infusion (64448). But, since they do not have the pump yet for a continuous infusion, they are injecting the medication through the catheter. Then they go back approximately every 12 hours (or as needed for pain control) and administer a follow-up (bolus) injection through the catheter. How should we code that?

Illinois Subscriber

Answer: As long as you have clear documentation showing that the provider followed up with the patient and managed the epidural, you can submit 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; and medical decision making that is straightforward or of low complexity) once daily for follow up on the femoral catheter. Remember, however, that 99231 cannot be billed for the date the catheter was placed.