Anesthesia Coding Alert

Follow these tips for smoother claims processing from start to finish Carrier requirements for reporting 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) for postoperative pain management vary greatly - so it's imperative that you check each individual carrier's policy for information in some key areas. Kick Things Off With Clear Documentation  Last month we began our look at post-op pain management by assessing documentation requirements:
  Get the surgeon's request for post-op pain management in writing, based on each individual case.
  Report the correct type of service (TOS) modifier (TOS 02 for medical service instead of TOS 07 for anesthesia).
  Thoroughly document the catheter placement to distinguish it from the means of anesthesia administration.
You'll report the actual catheter placement with either 62318 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62319 (... lumbar, sacral [caudal]). Once you've correctly documented these areas, start coding for the actual care. You should report 01996 for each day of post-op care, and the provider should document anything related to the patient's care. Details regarding the patient's level of pain and subsequent relief, medication plan and any side effects all help you accurately code the case. Append Modifier -59 for First Day Some carriers do not require modifiers to distinguish postoperative care from anesthesia service, but this can vary by state. Most carriers do need modifier -59 (Distinct procedural service) to distinguish post-op pain management from the anesthesia used for surgery, says  Kelly Dennis, CPC, ACS-AP, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. 
 
And some coders even recommend always appending modifier -59 to the case as back-up documentation, even if the carrier doesn't require it.
 
"You only report modifier -59 on the first day of post-op care," says Cheryl Pascale, CCS, a coder with Hackensack Anesthesiology in Hackensack, N.J. "I haven't had problems reporting modifier -59 with post-op care, but you should always check your carrier's policy." Factor in Carrier Caps Most patients typically do not need acute pain services beyond three days; sometimes even one or two days of care is sufficient. The anesthesiologist decides this as he assesses the patient during the follow-up visits. Patients might need longer-term post-op pain management because of:

  necrotizing fasciitis (728.86)
  multiple trauma (coded by the sites of injury)
  recovery from extensive surgery
  severe lung disease in which administering pain- relief shots or PCA (patient-controlled analgesia) could cause significant respiratory problems. "We commonly turn off the epidural but leave it in while we transition the patient to other analgesia," [...]