Know when 01996 is valid.
The descriptor for 01996 (Daily hospital management of
epidural or subarachnoid continuous drug administration) appears easy enough on
the surface, but can get complex in real-life coding. Read on for following
three scenarios and know how to handle each situation for an error-free ICD-9
coding.
Global Periods Assist Steer Your 01996 Use
Scenario 1: Your physician lately inserted an intrathecal
pump, which is a essentially three-day inpatient stay. You code the implant on
the first day, but require using a code for everyday management of the
intrathecal pump on respectively the second and third days. You used to report
01996, but lately started having difficulties getting it paid. Medicare also
says 01996 is general to the stay. How do you handle this for an error free
ICD-9 coding?
Solution: You must start by verifying the global period for
the service you're possibly coding. Code 62350 (Implantation, revision or
repositioning of tunneled intrathecal or epidural catheter, for long-term
medication administration via an external pump or implantable reservoir/infusion
pump; without laminectomy) has a 10-day global period. In case the pain
management specialist is carrying out 62350, then all services linked to the
catheter in the 10-day period following are covered in the initial fee.
Watch LCDs for State-Specific Directions
Scenario 2: The physician examines a patient on the hospital
floor and gives epidural catheter placement and management on different days.
The documentation is a restricted handwritten progress note in the chart. The
coder should define whether the note is sufficient documentation and requires
suggestions on how to talk with the physician about improved documentation in
the future.
Solution: If you want to ensure accurate ICD-9 coding , you
must check the LCD for 01996 in your own state. The documentation necessities
should be listed there, and then you can forward that to your physician as they
frequently want to see things in writing.
Tip: In case your state doesn't have an LCD for 01996, you
must check other areas.
Look for Services on Removal Day
Scenario 3: When is it suitable to bill 01996 for the last
day of management as well as catheter removal? You are divided between using
01996 or 99231 (Subsequent hospital care, per day, for the evaluation and
management of a patient, which requires at least 2 of these 3 key components
...) as no bolus is given, however the documentation doesn't meet the E/M
requirements.
Solution: Billing 01996 on the day of catheter removal rests
on whether the physician offers any other services for the patient that same
day. In case the physician eliminates the catheter and doesn't offer any other
services, never report an additional charge (catheter removal is an expected
service). For a perfect ICD9 codes, remember that in case your physician offers
other services and decides to remove the catheter the subsequent day, you can
then report 01996 for the day the services were carried out but not the day of
removal.
