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Thread: Daily rounds (01996)

  1. #1

    Default Daily rounds (01996)

    AAPC: Back to School
    Does anyone know the correct billing process for patient rounds with continuous epidurals? single injections?
    I've read previous posts and someone said each payor is different and some now have anesthesia global periods, in which case these rounds are not billable.
    Just wondering if this is the case or what the Medicare process is?
    Thanks for any help you may provide.

  2. #2
    Join Date
    Apr 2007


    Below if from the NCCI policy manual. I think for certain commercial carriers you will be able to find their individual policy in their anesthesia guidelines

    Management of epidural or subarachnoid drug administration (CPT code 01996) is separately payable on dates of service subsequent to surgery but not on the date of surgery. If the only service provided is management of epidural/subarachnoid drug administration, then an evaluation and management service should not be reported in addition to CPT code 01996. Payment for management of epidural/subarachnoid drug administration is limited to one unit of service per postoperative day regardless of the number of visits necessary to manage the catheter per postoperative day (CPT definition). While an anesthesiologist or non-medically directed CRNA may be able to report this service, only one payment will be made per day.

    Postoperative pain management services are generally provided by the surgeon who is reimbursed under a global payment policy related to the procedure and shall not be reported by the anesthesia practitioner unless separate, medically necessary services are required that cannot be rendered by the surgeon. The surgeon is responsible to document in the medical record the reason care is being referred to the anesthesia practitioner.

    In certain circumstances critical care services are provided by the anesthesiologist. It is currently national CMS policy that CRNAs cannot be reimbursed for evaluation and management services in the critical care area. In the case of anesthesiologists, the routine immediate postoperative care is not separately reported except as described above. Certain procedural services such as insertion of a Swan-Ganz catheter, insertion of a central venous pressure line, emergency intubation (outside of the operating suite), etc., are separately payable to anesthesiologists as well as non-medically directed CRNAs if these procedures are furnished within the parameters of state licensing laws.

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