Gastroenterology Coding Alert

Question: If the gastroenterologist performs a hernia repair on a 2-monthold infant that requires continuous infusion of anesthetic via catheter, can we report the infusion separately?

Florida Subscriber

Answer: No, you cannot. There are two hernia repair codes for 2-montholds, and catheter infusion of anesthetic (64416, Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) is bundled into both of them. When the gastroenterologist performs hernia repair on a 2-month-old with this type of anesthetic, you have two choices:

1. Report 49491 (Repair, initial inguinal hernia, preterm infant [less than 37 weeks gestation at birth], performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible) if there is no incarceration or strangulation.

2. Report 49492 (... incarcerated or strangulated) if there is incarceration or strangulation).

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.