Pain Management Medical Coding Training: Accurately Coding the Catheter Placement


Physicians place epidural catheters for postoperative pain management because patients undergoing certain types of surgery (e.g., thoracic) recover more quickly they ambulate sooner and have shorter hospital stays when postoperative pain is controlled by continuous infusion of pain medication. Read this expert medical coding and billing article to know more.

Sometimes a physician – and this is especially true in your cervical injections, maybe your thoracic but primarily, you will see this in a cervical. Occasionally, you will see providers use the catheter method for the lumbar when they want to get the most exact placement of the medication.

A physician will actually take a small catheter and thread it through a needle and when they do this in a cervical area it's for two reasons. One is that space up in the cervical epidural is very narrow and there are structures, certain vertebral arteries that one doesn’t care to interfere with when they are sticking needles up there.

So they’ll maybe use a catheter which is kind of a smoother way of doing the injection. And maybe it's just to try to get a better needle placement or the medicine in the most advantageous area. They’ll put the catheter in through the needle, inject and pull that catheter out immediately. The catheter does not remain in place.

The code 62318 is the medical coding option to report when that catheter is left in place. And that is of course most frequently done in the post-opt pain. Anesthesiologist frequently placed a catheter for continuous medication or to flow or for bolus injection. But that does not mean when you do a single injection that this code is billed just because the word “catheter” is in it.

Again, there has been some controversy and there are number of physicians that still contest this train of thought. To date, we have no information from the AMA that it is appropriate to use 62318 or 62319 when an injection is made, one single injection catheter immediately removed and the patient sent home.

There are number of occasions, some procedures where patients are going home with the catheter in place. Of course, if that is the case, then the provider would report 62318 if they placed the catheter and left it in place.

You might see that on pump trials. There's also infusion catheter, it's called ICE. And it's for a continuous infusion over two or three days. And then the patient is supposed to get better release. The question is how to code the placement of that catheter. And that would be medical coding option 62318 because it would be placed for continuous infusion over a period of time.