Anesthesia Coding Alert

Question: The anesthesiologist placed an indwelling thoracic epidural catheter at T6-T7 for a patient with a chest wall fracture of multiple ribs (the patient was admitted to the hospital). The infusion was a mixture of bupivacaine and fentanyl. The anesthesiologist followed up on the infusion for two days after insertion. Medicare denied our claim with 62318 for the epidural and 99232 for follow-up. How should we code this service? Rhode Island Subscriber Answer: You submitted the correct epidural code of 62318 (Injection[s], including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic). Append modifier 59 (Distinct procedural service) to indicate the epidural placement is separate from other services the patient received. You need to resubmit the claim with a different follow-up code, however. [...]