Anesthesia Coding Alert

Medicare will pay for placement of an epidural catheter in addition to administration of anesthesia if the catheter is placed solely for postoperative pain management, says Tonia Raley, CPC, claims processing team leader for Medical Information Management Solutions, a medical billing service in Phoenix. The patients anesthesia record must indicate, however, that the catheter administered no continuous anesthetic during the procedure.

Physicians place epidural catheters for postoperative pain management because patients undergoing certain types of surgery (e.g., thoracic) recover more quickly they ambulate sooner and have shorter hospital stays when postoperative pain is controlled by continuous infusion of pain medication.

Coding the Catheter Placement

An epidural catheter may be introduced at four sites along the spine. CPT Codes 2000 introduced two codes corresponding to these areas. Placement of a cervical or thoracic catheter is coded 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 lumbar or sacral introduction is coded 62319 ( lumbar, sacral [caudal]). Postoperative management of the catheters is coded 01996 (daily management of epidural or subarachnoid drug administration).

Modifier -59 (distinct procedural service) should be appended to the appropriate epidural catheter placement code if documentation shows that the catheter is for pain management and is therefore distinct and separate from the general anesthesia used for the procedure, Raley says.

For example, a pediatric patient undergoes a pancreatectomy. The general anesthesia is reported as an intravenous-inhalant combination, and a lumbar catheter is placed. At the start of surgery, 4 cc of bupivicaine is delivered via the catheter to test the catheters viability. The surgery lasts over six hours, during which no additional medication is injected into the catheter. An hour before the surgery ends, a second, smaller dose of medication is pushed through the catheter, followed by a third small dose at the end of surgery.

In the recovery room, the physician (either a pain management specialist or the surgical anesthesiologist) writes orders for an epidural medication cocktail. The recovery room nurse fills the order and hangs the bag of medication to begin a continuous infusion via the previously placed catheter. The physician follows up on subsequent days to ensure the medication levels are adequate and orders are written.

This is an excellent example of when the epidural procedure is separately billable in addition to the global anesthesia care, says Martina Heasley, CPC, an administrator in the department of anesthesia at [...]