Anesthesia Coding Alert

Question: A pain-services anesthesiologist placed an epidural to use during a hysterectomy and for post-op pain control. Another anesthesiologist sedated and monitored the patient during surgery. If the pain physician bills for the epidural placement, how should we bill for the anesthesiologist in the operating room?

Maine Subscriber

Answer: First, remember that you cannot bill for postoperative pain management if the anesthesiologist uses the same epidural to deliver surgical anesthesia. (You would bill the epidural if the anesthesiologist placed it on a different day than the surgery or if he or she placed it prior to surgery but didn't use it to deliver anesthetic during the procedure. But if the provider delivered anesthesia via the epidural, its placement is part of the procedure and its insertion is included in the global anesthesia fee.)                                                                                            

The pain management physician should not charge for the epidural in your example. He can only bill 01996 (Daily hospital management of epidural or subarachnoid continuous drug infusion) and must waive his fee for the epidural placement (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]) if he administered it on the same day as the surgery.               

 The anesthesiologist in the operating room should report 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified) with the appropriate number of time units.

These cases often use MAC, so append modifier -QS (Monitored anesthesia care service) to the anesthesia code if appropriate.