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CPT Code 01996

  1. #1
    Default CPT Code 01996
    Medical Coding Books
    Does any one know if your anesthesiologist are supposed to document time when they use the subsequent anesthesia visit code?

  2. #2

    I have never seen formal documentation requirements for ASA code 01996. In the ASA Relative Values Guide is does indicate 01996 base unit value is listed as 3 only (no "+ TM" noted as it does on the time based ASA codes). While my providers do not document start/stop times per se they do, however, date and time their epidural round documentation note in the Progress Notes.

    Julie, CPC

  3. Default
    Time is not billable with 01966. However, the docs should be documenting the date/time in the patient's charts for all visits/rounds.

    LaSeille Willard, CPC

  4. #4
    Virginia Beach
    Default Payor denying 01996 for start/stop time
    It doesn't make sense to me, but our anesthesiologist provided the GA for procedure and inserted epidural same OR session. We billed the Anesthesia (with start/stop times of course) and the epidural insertion (62318) day 1, redose mgmt (01996) day 2 & day 3 on same claim. Payor paid all. Patient received an additional day of redose mgmt, which was billed on next claim - payor denied this claim stating provider billing error and remit advice states rebill start/stop times. WHAT?????? I DISAGREE and cannot find anything in the CPT guidelines that agrees with that, in fact, it describes time reporting for anesthesia required for when anesthesiologist prepares patient in the OR....etc. Anyone know more on this? Thanks

  5. Default
    maybe you forgot to take the physical status modifier off the claim, it happens to us...

  6. #6
    Virginia Beach
    Thanks for response - but, no PS mods on claim - just perplexing denial here. In our opinion, it is incorrect to apply start/start times to this code. Does not make sense.

  7. Default
    you are correct, we never bill with time or modifier (if alone), we usually use dx: 338.18 for post-op pain & get paid, I would try calling to ask why they need time, maybe they just want it documented on the progress notes.

  8. #8
    Virginia Beach
    Thanks to all for comments - We did contact a supervisor for this payor, got a response this morning that our claim will be reprocessed for payment, they stated there is an exception to the start/stop time rule for CPT 01996, it does not require start/stop time to be billed

  9. #9
    having the same issue... our drs provide the pain epidural the day of surgery, following day, do follow up visit--99231. 2nd day, again uses the 99231, and so on. Recieving TONS of denials from health america/advantra( all coventry based insurance plans), they are stating within the global surgical period. What kind of documentation or what do we need to do in order to get these claims paid? I have appealed the one and denied again stating within global period.

    Any thoughts or suggestions...would be GREATLY appreciated

  10. #10

    First, if providing continuous "epidural" postoperative pain management service the code would be 01996 and not 99231.

    Second, if providing continous peripheral nerve block postoperative pain managment service, many insurance carriers have implemented a "global period" for anesthesia. You will need to clarify by payer what they are defining as the global period and, if appropriate, add the -24 modifier to the E&M code(s) for the continuous peripheral nerve block rounds if they are not related to the anesthesia service.

    For example, UHC has anesthesia global period information in their written anesthesia policy which may be viewed at

    Hope this helps.
    Julie, CPC

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