Anesthesia Coding Alert

Hint: It’s not your typical post-op management

If your physicians enjoy using different pain management techniques, you’ve probably run across some procedures involving Duramorph rounding, but opinions on how to correctly code the service vary. Understand the Duramorph Difference  Duramorph -- also known as Astramorph or preservative-free morphine -- is a systemic narcotic analgesic administered through a spinal or epidural catheter, says Tonia Raley, CPC, claims processing manager for Medical Information Systems in Phoenix. Physicians rely on Duramorph to manage pain in patients who do not respond to non-narcotic analgesics.
 
“Duramorph provides an extended period of pain relief without the loss of sensory, motor or sympathetic function,” says Cynthia Mulkey, marketing manager for anesthesia and consulting at Per-Se Technologies in Atlanta. A single dose of Duramorph can relieve the patient’s pain for 12 to 24 hours.
 
Anesthesia providers often use Duramorph for pain relief following a patient’s cesarean section. Administering Duramorph differs from a standard epidural or spinal catheter in several ways:
 
• Physicians administer Duramorph as a single-shot injection or through a catheter they plan to remove, not as a continuous epidural or spinal catheter.
 
• One dose of Duramorph is usually sufficient for pain relief, instead of re-administering doses every few hours.
 
• The timing for Duramorph administration is trickier than with other pain management techniques.
 
• Physicians often mix Duramorph with the drugs given spinally for a cesarean section. If your anesthesiologist uses this technique, he might list Duramorph on the anesthesia record with other medications administered spinally.
 
• If your anesthesiologist administers Duramorph epidurally, he gives it separately through the patient’s epidural catheter after the obstetrician clamps the umbilical cord. The epidural dose of Duramorph can be up to 25 times greater than the spinal dose. 
 
The anesthesiologist does not leave a catheter in when he uses Duramorph epidurally. Instead, he waits until the obstetrician clamps the umbilical cord to minimize any effect the drug might have on the infant. Then he administers the dose of Duramorph either through an existing epidural catheter or by an injection into the intrathecal space, Mulkey says.
 
When administering Duramorph, the anesthesiologist uses the same technique (epidural or spinal) as during the cesarean section.
 
Technique Dictates Your Coding When you code this type of care, remember that the original anesthetic includes the patient’s first day of postoperative pain management -- that is, the code you reported for the labor and delivery, such as 01967, Neuraxial labor analgesia/anesthesia for planned vaginal delivery [...]