Wiki Anesthesia pain management 01996

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01996 is for follow-up mgmt of catheter placement (62318-62319 & any other epidural or subarachnoid drug administration), you have to code (62318-62319, etc) 1st to be able to code 01996 for F/U pain mgmt starting the day after the initial placement of the catheter.

shold look like this:
62318-59 (use mod-59 if proc done for post-op pain mgmt on the same day of surgery)
01996 for catheter mgmt for subsequent days

this means that 01996 cannot be used alone for f/u, there has to be a catheter placed before.

Erika.
 
our practice is running into the same problem, the 99231 code is getting several denials from different insurance companies stating included in the surg global fee, anesthesia for pain management fu should not be getting this denial, i spoke to our administrator had told me to correct any denials with appeals and use the 01996 but one of my fellow coders didnt think this was appropriate. can i get some reassurance on this? the catheter was already placed the day before (same day as the surg) post op visit was done day after and health america/advanta/coventry health feels this is included.

thanks for any and all information, greatly appreciate it
 
OK - we've got two separate issues being discussed in the post.

1st - code 01996 is only appropriate for rounding/daily follow up on a continuous epidural/subarachnoid catheter

2nd - rounding on OTHER continuous catheters
We also bill an E&M for rounding on the continuous peripheral nerve blocks. CPT codes 99321 series for inpatient / 99212 series for outpatient and have received a few denials. What I have found out so far is that SOME insurance companies are applying a global period to anesthesia even though neither the ASA code or the block code has a global period. I suspect some are confusing postop pain management (which is billable) with the anesthesia postop visit (which is not billable). We have been investigating these by payer as they occur and taking appropriate action -- most request the -24 modifier on the E&M code. I would NOT suggest simply applying the -24 modifier to all of your E&M postop pain round charges as we have discovered varied interpretations. It's important that we, as billers, understand the necessity and appropriateness of all modifiers.

For example,
WPS Medicare has stated that anesthesia codes have a 5 day global period BEFORE and AFTER the DOS which they have interpretted that any E&M by the SAME anesthesiologist as performing the anesthesia service. They have instructed us to bill the -24 when the postop round is performed by the SAME anesthesiologist within the 5 day postop period.

UHC has a 1 day anesthesia global period and it's in their Anesthesia Policy that the -24 or -25 modifier would be necessary for payment.

Hope this helps.
Julie, CPC
 
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