Anesthesia Coding Alert

Question: Our anesthesiologist inserted a lumbar epidural catheter to manage post-op pain following a total knee replacement procedure. The catheter was connected in the postanesthesia care unit to medication as a continuous infusion. Can we bill for this separately? Also, what if our anesthesiologist visits the patient the next day to see how the continuous epidural is working? Can we also bill for this visit separately?

California Subscriber

Answer: If your anesthesiologist did not use the epidural catheter as a means of anesthesia for the surgery, then you can use 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]), to report the epidural catheter placement. Because the block is performed on the same day as surgery, make sure to append modifier 59 (Distinct procedural service) to 62319. This communicates to the payer that your provider performed the epidural procedure for post-operative pain management only and not as a means of anesthesia for the total knee replacement.

Watch your step: Same-day visits by your anesthesthesiologist after post-operative placement of the epidural catheter are not separately billable. However, if your provider needs to see the patient on subsequent days to manage the continuous pain management infusion, then as directed by the CPT parenthetical note "Report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) for daily hospital management of continuous epidural or subarachnoid drug administration performed after insertion of an epidural or subarachnoid catheter." You should report 01996 once per day as it includes all E/M services associated with the continuous infusion management regardless of how many times the doctor saw the patient.