# Pca



## ndugger4 (Sep 21, 2008)

Does anyone know what code you would use for PCA?  I've got an anesthesiologist that's wanting to bill for PCA.

Thanks.


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## amolson1325 (Sep 21, 2008)

Is this for the placement of the infusion pump for PCA?


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## ndugger4 (Sep 21, 2008)

Both placement and follow up.


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## kamala (Sep 22, 2008)

Hi, 


For PCA , the CPT used would be 62319 .

IF the pain mgt is for the reason of post operative and the primary procedure performed is with General anesthesia , the CPT Should be 62319-59 modifier appended , since PCA done on the same DOS of surgery is inclusive with primary procedure , if the type of anesthesia is through the spinal approach , where the Anesthetist would have not did , any extra service , wherin in General anesthesia , he has to spend time for placement of the epidural Catheter .

The follow up code would be 01996 .


Regards, 
Kamala CPC


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## Anna Weaver (Sep 22, 2008)

*pca*

Am I wrong in thinking this is patient controlled analgesia and not an epidural? I thought the PCA was an unchargeable item and used as part of the surgery/anesthesia. It should be documented, but not charged.


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## ndugger4 (Sep 22, 2008)

Anna,

You are correct, that is what I always thought, but I have been told that Texas BCBS will pay for follow up days and I needed to do more research.  Do you know if there is a code for placing the infusion pump?


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## amolson1325 (Sep 22, 2008)

What about 36563??


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## Anna Weaver (Sep 22, 2008)

*pca*

Well, I'm not sure where to go for this one then, as CMS says of Pain management "However, normal postoperative pain management, including management of intravenous patient controlled analgesia, is considered part of the surgical global package and should not be separately reported." This is in the "Anesthesia Billing Guide" by CMS Oct 2007.
The 36563 would work for the infusion pump I would think. 
You guys always give me so much to think about!!!


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## amolson1325 (Sep 22, 2008)

Isn't that great Anna, I may not have a job but at least this keeps my brain going in the mean time!

Ok....I think the 36563 would work unless it was more than a pump. 

_"Pain management services are usually provided by an anesthesiologist, when billing for pain management services, it is important to remember that the anesthesiologist is actually performing the procedure itself and that the charges should be submitted as surgery codes rather than anesthesia codes." _

You will have to check if the follow up will be part of the package??

I hope that helps a little!


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## kamala (Sep 23, 2008)

*pca*

PCA are provided , not only to the Post operative patients , it is also to the end care patients like cancerous conditions where the patient would be in 
radiation / chemotherapy , to reduce the pain the patient would be appointed for PCA .

Any service that is provided by the anesthetist is billable, which is additional to the routine care.

If that is going to be the Post operative care, then the approach to reduce the pain could be through the blocks / epidural cath .

 If that is going to be the block ,it is just administration of anesthetic agent near the nerve area ( site specific ).

IF that is going to be through Epidural cath  , the aim is to anesthetize say - body part – upper trunk / lower trunk.

If the anesthetist is inserting a catheter to make the patient independent to administer the narcotic substance (pre set) without the Anesthetist assistance in future, the necessity of PCA arises.

Patient stay in the Hospital might be for day or two for which the Anesthetist would be guiding the patient how to do the PCA administration   at times just an supervision which will be billed as 01996. 

The epidural could be 62319 / 62318 and if is done during the operative session then will not be paid separately , but in case the Dr. is performing the surgery with the General anesthesia , and he needs to do some intervention for the epidural cath insertion , then 62319/62318  will be billed with –59 mod.

Otherwise, just for management 01996 will be paid..

More over , I don't think  36569 would be an appropriate CPT , since anesthetic agents will be administered through Vascular , but through Nerve / nerve roots / Cord  /general sedation !!!

any thoughts ??

Regards,
Kamala CPC


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## FractalMind (Sep 23, 2008)

*Still confused about PCA*

Hi Kamala, I'm an Anesthesia Coder and we have two offices that bill differently for PCA, I don't understand when the Dr. marks "PCA" or "F/U visit for pain management" we usually bill code: 99231=2 units for the 1st and all subsequent days of Dr F/U, we usually get progress notes with the anesthesiologist notes for the pain check up on the patient, but NOTE that there's not always a catheter so we cannot bill for 01996 (unless 62318-62319). what do you think we can bill for the "PCA" or "F/U visit for Pain Mgmt" which are documented in progress notes when there's no 62318-62319 placed?

Thanks!


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## hgolfos (Oct 3, 2008)

*PCA Billing*

PCA is for Patient Controlled Analgesia.  Medicare does not pay for this service so don't bother trying to bill it to them.  Other carriers vary on their acceptance of this type of pain management.  I have seen physicians use it for both pain control, and post operative pain relief.  It *can *be billed separately from the main procedure.  You need to check with your carriers to see which codes they prefer.  We bill in Alabama, BCBS of AL and Workers Comp want 01999, Medicaid and commercial carriers want 90765/90766 and United Healthcare wants 62319.

If your carrier does not have any specific guidelines regarding PCA's try 90765 and 90766 for the initial day and 90766 for follow-up days.  It is always a good idea to have documentation on file including  the order for the PCA as well as the notes regarding placement, management and D/C date.  

If you are coding for postoperative pain be sure to code v58.49 for post-surgical states as your secondary code.

Hope this helps.
Heather


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