Anesthesia 101 01996

What would you code in the following situation?

A 58-year-old female patient undergoes a bilateral total knee replacement.  After the appropriate recovery room time, she is transferred up to a floor.
Because the surgeon feels the patient is going to need that extra pain control through the catheter, he chooses to leave it in place.
The following day, the anesthesiologist (or CRNA for some states/localities where permitted) makes their rounds to check on their patients.
This female patient expresses she continues to have significant pain, so medication given is adjusted to accommodate the patients comfort. How would you code this scenario?

In this case, capture ASA code 01996 for daily management of epidural or subarachnoid drug administration.

This is separately payable on dates of service after surgery but not on the day of surgery.

Compared to other anesthesia codes there are several things to note:

  • It is not recognized for time, but instead, only base units.
  • It is limited to once per day regardless of the number of visits necessary to manage the catheter.
  • It should not be reported with physical status modifiers nor any of the qualifying circumstance codes
  • CMS also states that if the only service provided is the management, then a separate E/M service should not be reported in addition to 01996.

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Mary is a consultant for The Haugen Consulting Group with over 25 years of health care industry experience. She started her career in Orthopedics which was her passion for decades. In addition to Orthopedics, she provides expertise in other specialties such as Anesthesia, Ambulatory Surgery Center, as well as most surgical specialties . She has experience working the professional fee side of coding, audit, education as well as compliance, serving both coders and physicians, as well as the surgical side. She is a Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Anesthesia Professional Coder (CANPC) Certified Ambulatory Surgery Center Coder (CASCC) and Certified Orthopedic Surgery Coder (COSC).

During her free time, she loves to do crafts, enjoys the outdoors, and the Broncos! She has 4 daughters, and 10 grandchildren which light up her life.


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