Anesthesia Coding Alert

Pain-management physicians are sometimes called in to manage postoperative patients who received an epidural catheter during surgery billable with 01996 (daily management of epidural or subarachnoid drug administration). Some carriers reject the code because they mistakenly think that all anesthesia codes are billed based on time 01996 is not.

To get paid on first submission for a billable service, some pain practices drop 01996 and bill a low- to midlevel subsequent inpatient visit (99231-99233) instead. Such billing is inappropriate, coding experts say, unless the physician fulfills the requirements for an E/M visit, which is not normally the case for daily epidural management.
 
In most cases, acute postoperative pain-management services are provided by the surgeon and are included in the procedure's global surgical package. The patient's acute postoperative pain is sometimes severe enough to require consultation or treatment by a pain physician. These specialists may also be asked to implant an epidural catheter to deliver the pain medication postoperatively.
 
"The request from the surgeon to manage the postoperative pain and the medical necessity should be documented in the patient's chart," says Martina Heasley, CPC, an administrator in the department of anesthesia at Stanford University in Stanford, Calif.
 
The pain specialist orders the appropriate medication that is administered to the patient by infusion via the catheter installed during the operation. In the following days, the pain physician checks the patient to inspect the catheter site and to ensure the correct orders have been written and the patient's medication levels are correct.
Coding Services Separately
The catheter placement and the daily medication may be covered separately under certain circumstances. For example, Medicare will pay for the epidural catheter placement and the pain medication if the catheter is placed solely for the purpose of postoperative pain management.

The patient's anesthesia record must state that the catheter was not used to administer anesthesia during the primary procedure.
 
Note: For a detailed discussion on coding and billing of epidural catheter placement, see Pain Management Coding Alert, Second Quarter 2001, Vol. 1, No. 1, page 1.
 
If the surgeon placed the catheter, the pain specialist can bill for postoperative pain-management services beginning the day of the procedure. However, the pain specialist normally begins to bill for the inspection of the catheter site and management of the patient's medication on the day following the surgery.
 
This service should be reported using 01996, says Devona Slater, CMCP, an anesthesia and pain-management specialist in Leawood, Kan. "Unless the patient has another problem that requires the physician to fulfill the [...]