Anesthesia Coding Alert

Question: Our physician inserted a catheter for pain relief. When the patient returned to the clinic several days later for catheter removal, the physician charged an E/M service. Can we bill the removal separate from the initial catheter placement?


New Mexico Subscriber
 

Answer: Begin by verifying what type of catheter the physician inserted. Femoral (64447-64448) or brachial plexus (64415-64416) catheters have global periods that can last up to 10 days. If your physician inserted one of these catheters, the global period includes its removal -- which means you cannot bill it separately.

Other types of catheters have shorter global periods -- or even no global period -- so you can report the catheter placement and removal. These options include continuous epidurals 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) and 62319 (... lumbar, sacral [caudal]). If your physician used one of these catheters, you can report its removal with an E/M code such as 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...).

If your physician completes an expanded history and physical, you might be able to report 99213 instead.