Wiki daily epidural

[BrandiF]

A patient comes to the pain clinic for postherpetic polyneuropathy. On Monday Dr places an epidural at T3-4 level using fluroscopy, injects bupivacaine with epinephrine, leaves the catheter in place, covers it with a dressing. On Tuesday, Wednesday, Thursday and Friday the patient returns to the pain clinic and has additional bupivacaine with epinephrine injected and the catheter removed on Friday. How would you code for this? I am not able to use the 01996 daily management code because it is not an inpatient. I originally thought of Monday 62318, 77003-26, and Tues-Fri 62310. I am questioning this, however, because the code description for 62310 states that it is a single injection, not indwelling catheter. I am wondering about reporting 62310 x 5. This seems not quite right to me because the doctor is not placing the epidural each day. Any feedback or guidance is appreciated!

 

[dwaldman]

"Effective January 1, 2004, daily hospital management of continuous epidural or subarachnoid drug administration performed on the day(s) subsequent to the placement of an epidural or subarachnoid catheter (CPT codes 62318-62319) may be reported as CPT code 01996."

Above is from the anesthesia section of NCCI policy manual.

I was wondering if you were describing an single injection with subsequent injections within the placed catheter. I asked because you don't describe the procedure as an infusion. When reviewing the WPS Medicare J5 LCD for injection into the spinal canal which includes epidurals and also CPT 01996, it points out:

Post-operative pain management services should be reported in the inpatient hospital setting (21) only.


But the physician you are billing for is not providing post-operative pain management immediately following a surgery. I feel if this is the statement you are referencing regarding the POS of 21 with 01996 that it does not pertain to the type of circumstance you are billing. I feel that for monday if this is a single injection with a catheter placed with the anticipation of additional single injections on separate days then monday could be billed as 62310/77003 and for the additional days that would have be unlisted or confirm that the carrier you are biling will accept billing the epidural code separately for 4 separate days.

If this was infusion the first day under 62318/77003 the first day, were there a continous infusions on 4 other days? If not 01996 would not be able to billed and then you have confirm the CPT for billing an single injection where the needle is placed in the secure catheter.

Another thing is if you are billing 5 epidural codes in 5 consecutive days this might not be in the general indications and limitations of the LCD or medical policy of the carrier you are billing.

Below is from WPS Medicare J5 LCD for Injection into the Spinal Canal

General Indications and Limitations
Epidural (interlaminar/translaminar or caudal) and transforaminal epidural corticosteroid injections should not exceed a series of three, per spinal region, within a six-month period when used as treatment for a pain disorder other than treatment for cancer pain. These may be performed at intervals of one week or greater. With each subsequent injection the medical record should clearly document the interval effects from the prior injection(s). Appropriate reasons for a repeat injection are: (a) significant improvement in the patient's symptoms from the prior injection, even if relapsed, or (b) carefully documented technical reasons that it is appropriate to repeat the procedure even if no prior improvement and (c) patients with persistent pain in whom the imaging findings suggest that the pathology should respond to corticosteroid injection. In the absence of a compelling technical reason, it is not appropriate to repeat a procedure a third time if there has been no improvement from the two preceding.



13. The epidural catheter insertion (CPT codes 62318 or 62319) includes the setup and start of the infusion. Therefore, the daily management of epidural or subarachnoid drug administration (CPT code 01996) should not be billed for the same day as the catheter insertion.

14. The daily management of epidural or subarachnoid drug administration (CPT code 01996), is a daily service and should only be coded with a number of services (NOS) of one (1) for each day billed. Post-operative pain management services should be reported in the inpatient hospital setting (21) only.