Anesthesia Coding Alert

Question: I received a denial from Medicare for an epidural injection (62311) when billed with an A-line (36620). Is this a new edit?

North Carolina Subscriber

Answer: Effective April 1, 2009, CMS bundles 62311 (Injection, single [not via indwelling catheter], 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; lumbar, sacral [caudal]) and most of the nerve block codes -- such as 64415, 64416, 64417,64450, etc -- into the following codes:

• 36620 -- Arterial catheterization or cannulation for sampling, monitoring or transfusion [separate procedure]; percutaneous

• 36556 -- Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older

• 93503 -- Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes.

No bypass modifier is allowed -- the modifier indicator is 0. The Correct Coding Initiative edits are available at www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/List.asp.