Anesthesia Coding Alert

Question: Our provider used monitored anesthesia care (MAC) for the primary mode of anesthesia during a procedure. He also inserted a femoral nerve continuous catheter and documented that the catheter was for postoperative pain relief. Can we bill separately for the continuous catheter?

Florida Subscriber

Answer: No, you cannot bill the catheter separately. According to Chapter 2 of the National Correct Coding Initiative (NCCI), you cannot report the catheter separately unless the primary mode of intraoperative anesthesia was a general, subarachnoid or epidural injection. The adequacy of the intraoperative anesthesia must not be dependent on the nerve block injection. Since MAC was the primary mode of anesthesia in the scenario you describe, you should not report the catheter separately.

However, as long as your provider documented the time it took to place the catheter, the “discontinuous” time may be added to anesthesia time reported.

If the primary mode of anesthesia was not MAC, you can report the continuous catheter separately, as long as your provider adequately documented that the continuous catheter would be used for postoperative management and was not used for the mode of anesthesia during the procedure.

Report the catheter placement with 64448 (Injection, anesthetic agent; femoral nerve, continuous infusion by catheter [including catheter placement]). In this example, the time spent on placement of the block is not reported with anesthesia time, although you do not need to deduct time if the post-surgical block occurs after induction and prior to emergence. Append modifier 59 (Distinct procedural service) to emphasize the catheter’s separate use.

Follow up: If you’re able to code for the catheter placement, you can also report additional days if your physician provides follow up care during the postoperative period. Do not report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) as this code represents daily hospital management of an epidural or subarachnoid catheter. You may report subsequent hospital care codes (99231-99233), depending on the documentation provided, for each day of medically necessary follow up care.