Anesthesia Coding Alert

Question: Our providers have changed how they’re handling some post-op anesthesia cases. For saphenous/femoral nerve blocks after some knee and shoulder replacement surgeries, they’re inserting a catheter as they would for a continuous infusion instead of just injecting a nerve once. But since they don’t have a pump yet for a continuous infusion, they’re injecting the med through the catheter. They go back about every 12 hours (or as needed for pain control) and administer a follow-up bolus injection through the catheter. How should we code this?

New Hampshire Subscriber

Answer: As long as you have documentation showing that they followed with the patient and managed that epidural, you can bill 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity) once daily for follow-up on the femoral catheter. Remember, however, that the service cannot be billed on the same date the catheter was placed.