Anesthesia Coding Alert

Question: If the anesthesiologist uses general anesthesia for a total shoulder replacement and places an interscalene catheter for postoperative pain management, can we bill for each service? The codes are straightforward, and I don’t need the codes. I just need to know whether we can bill for both or if they are considered bundled. Since 01996 specifies daily management of an epidural or subarachnoid continuous drug administration, what code do we report for follow-up of the interscalene catheter?

California Subscriber

Answer: As long as documentation supports both general anesthesia and the post-op interscalene block, the National Correct Coding Initiative (NCCI) allows separate billing of both services. Documentation should show that the anesthesia provider placed the interscalene block at the request of the surgeon (a written request is best practice), the block was not used as the mode of anesthesia (general anesthesia is the mode in your example), and anesthesia time is not separately charged for placing the block prior to the patient’s induction. To see the American Society of Anesthesiologists’ statement on the topic, visit www.asahq.org/standards-and-guidelines/statement-on-reporting-postoperative-pain-procedures-in-conjunction-with-anesthesia.

Follow-up: You are correct that 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) applies only to a continuous epidural or subarachnoid catheter. To report follow-up on subsequent days for other continuous catheters, the anesthesia provider must document their interaction with the patient to meet the requirements for an evaluation and management (E/M) code. This includes the reason for the visit (chief complaint is usually postoperative pain), as well as a medically appropriate history and physical examination.

According to Medicare’s National Correct Coding Initiative Policy Manual, Chapter II, Section B.8, “pain management services subsequent to the date of insertion of the catheter for continuous infusion may be reported with CPT^® code 01996 for epidural/subarachnoid infusions and with E&M codes for nerve block continuous infusions” (www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare).