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 this was the only service provided, you should code 64449 (Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration). The descriptor for 64449 specifies that it includes daily management for anesthetic agent administration, so it should not be reported with 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration). Code 64449 also includes a 10-day global period, so all charges associated with the catheter billed with 64449, from insertion to day 10, are included in the 12-units charge.

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.

Take note: 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 report the appropriate anesthesia services code(s).

There is no specific CPT code for "daily" management of a plexus nerve catheter, because the insertion has a long global period. You should not use 01996, as this is specific to epidural and subarachnoid catheters. Also, "Carrier-specific 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.