Orthopedic Coding Alert

Question: At the conclusion of a rotator cuff repair, one of our physicians placed an indwelling epidural-type catheter which was to be used postoperatively for continuous anesthetic pain control in the patients home. The catheter was not placed in a vein but in the subacromial space. Is this type of catheter placement considered a bundled service or can we bill extra for this and, if so, what CPT code should we use?

Camille H. Norris, CPC
Pamlico Orthopedics, Washington, NC

Answer: According to the American Academy of Orthopedic Surgeons (AAOS) Global Service Data Book for Orthopaedic Surgeons, the insertion, placement and removal of catheter(s), irrigation tube(s), surgical drain(s), suction device(s) or re-infusion device(s) are included in the major procedure. The placement of an indwelling epidural catheter (continuous), is generally performed by an anesthesiologist, since an epidural is placed over or upon the dura, which is along the spinal cord. Orthopedists may dictate that this was done, but be sure to check that the surgeon actually performed this procedure, as orthopedists dont ordinarily accept the risk and complications that accompany the epidural placement. Anesthesiologists, on the other hand, perform this procedure quite often and would code the procedure depending on location, such as: subarachnoid or subdural epidural (continuous) using 62277, and an epidural, lumbar or caudal using 62279.