Anesthesia Coding Alert

Question: Our anesthesiologist placed a catheter for anesthetic at the lumbar plexus, and made visits to the patient for several days. Should I code 01996 or 64449?

Wisconsin Subscriber

Answer: If the catheter placement was the only service the anesthesiologist provided, code with 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration). Global days were removed from code 64449 in 2009, and an Evaluation/Management code that meets the of service documented may be reported for the patient visits.

Check it out: Before filing a claim for 64449, check with your payer to see if it publishes guidelines for continuous infusion. Some insurers consider these services medically unnecessary and/or investigational.

Background: According to CPT Assistant (May 1999), reporting of plexus nerve catheter placement is based on:

• exclusion of other anesthesia service(s)
• performance of concomitant operative service(s) by same physician
• target nerve involved.

If the physician placed the catheter primarily for anesthesia administration during an operative session, then you should only report the appropriate anesthesia services code(s) for the initial date of service.

CPT does not include a specific code for "daily" management of a plexus nerve catheter. Code 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) is not appropriate, as the code specifically addresses epidural and subarachnoid catheters. Also, "Carrierspecific guidelines may apply if daily catheter management or injection is performed during the immediate postoperative period of another procedure or service," according to CPT Assistant.