Anesthesia Coding Alert

Question: Our anesthesiologist provided an epidural to an OB patient for cesarean section. She used a specific brand-name preservative-free morphine. Should I use 01996 to code for use of the drug during the procedure?

Arizona Subscriber

Answer: You would not report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) because preservative-free morphines, such as Duramorph or Astramorph, are administered with a single application. So even though it is administered through the catheter, it is not administered continually as the code descriptor for 01996 indicates.

A preservative-free morphine, such as Duramorph, is often given spinally or by epidural for C-section pain  or for large episiotomy repair. Physicians often mix Duramorph with the drugs given spinally for a cesarean section. If your anesthesiologist uses this technique, he might list "spinal morphine" on the anesthesia record with other medications administered spinally.

Don't miss: The patient should have respiratory monitoring after administration, however, due to the risk of respiratory distress. So you would need to separately include 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient ...). If your physician gave preservative-free morphine and subsequently managed the patient's post-op pain, you would then be able to bill 99231 on the first day of post-op care.

Remember: When you code this type of case, the original anesthetic includes the patient's first day of postoperative pain management -- that is, the code you reported for the labor and delivery, such as 01967 (Neuraxial labor analgesia/anesthesia for planned vaginal delivery [this includes any repeat subarachnoid needle placement and drug injection and/or any necessary replacement of epidural catheter during labor]) and +01968 (Anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia [List separately in addition to code for primary procedure performed]).