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Anesthesia Coding Alert

READER QUESTIONS:

Don't Bill Preservative-Free Morphine Separately

Published on Sun Jan 25, 2009

Question: Duramorph is a narcotic that may be administered as a single injection prior to removing the epidural catheter used for OB cesarean deliveries. The patient must be monitored for at least 24 hours after administration because of the risk of respiratory distress. Is the monitoring billable or is it included in the epidural injection? If the monitoring is billable, would you use 99231 or 01996?

Washington Subscriber

Answer: You can not bill the monitoring separately as 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) unless certain conditions are met. To report this code, documentation must support the service, and the monitoring you describe doesn't meet those requirements. The anesthesiologist does not perform the monitoring, and monitoring is never billable.

Some physicians may mark 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) in error on their charge ticket for this type of hospital visit. Note the term "continuous drug administration"in the CPT code description. This requirement precludes reporting 01996 for the hospital E/M service.

Exception: If there is a continuous infusion connected to the existing epidural or intrathecal catheter, you may bill 01996. If the catheter bolused at the end of the surgical procedure and is then removed, the real issue is:

Does the scenario support medical necessity for a separately billable E/M inpatient subsequent hospital care code, or is the visit included in the anesthesia package of services already billed with the anesthesia code?

If your physician gave preservative-free morphine and managed post-op pain, a visit that meets all the requirements of 99231 could be billed on post-op day one.

The drug: Preservative-free morphine (Duramorph) is rarely given epidurally for a routine vaginal delivery, but it is often given spinally or by epidural for C-section pain, or for large episiotomy repair.

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