Anesthesia Coding Alert

Question: My anesthesiologist recently inserted a pre-operative lumbar epidural catheter prior to providing general anesthesia. I'm wondering why he performed the insertion that way, at that particular time. I'm also wondering, of course, if I can bill for it. What codes should I use?

Florida Subscriber

Answer: You will 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 this procedure. You should append modifier 59 (Distinct procedural service) to show the catheter procedure was separate from the anesthesia service. Your anesthesiologist's documentation should also show that fact, in order to prove medical necessity.

A lumbar epidural is traditionally inserted preoperatively, when the patient is able to assume the correct position for the insertion. This is usually done in the sitting position or with the patient lying on her side. Also, these blocks are inserted near the nerves of the spinal cord, so it is usually safer to do this in a patient who is awake. The patient would be able to tell your anesthesiologist if the needle is causing pain that could progress to nerve damage if unrecognized.