# pain pump trial



## beatet66 (Aug 13, 2013)

Hello,
I would like to clarify the following scenario:
a patient is undergoing a Pain Pump Trial (CPT62319)
When the patient came back for one of her follow up visits she was given a bolus:
"She finally had a very good day after infusing through a period of 24 hours for a total of 2.4 mg on a given day. At this dose she was able to tell that the medicine is helping. Today we increased the rate to twice as much. Additionally I gave her a bolus of 0.3 mg over 5 min. This could be the last day of the trial as it showing so good progress.
Let me document for the record that I administered a bolus of 0.3 mg of preservative-free morphine via an indwelling epidural catheter today. The procedure was done using strict sterile technique and the patient was observed for 15 min. after the procedure for any adverse effects of which she had none."
Does this support billing CPT 62311 plus the ov charge?
Any help would be greatly appreciated.
Thank you!


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## mcnaryk (Aug 13, 2013)

I've found Medtronic's website to be a GREAT resource in billing these pain pump scenarios-I would try that. I think it's Medtronic.com, then look for Physician or Provider, then Billing/Reimbursement. There are PDF's for all of their products with both ICD9 and CPT codes.


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## dwaldman (Aug 14, 2013)

I would use 01996 for the second day. 

Here is a private response I received regarding this issue

If the patient presents for a epidural catheter infusion of steroids and anasthetic. Following the procedure, the catheter is secured and the infusion is stopped. The patient stays over night in the hospital. The next day they are taken back to the OR room and under fluoroscopic guidance a bolus is performed thru the previously placed catheter. For the second day, would it be appropriate to report 01996 or 62310 if the previous catheter insertion from the prior day was within the cervical region? 62310 was suggested since this is procedure in the OR for the second day under fluoroscopic guidance, but the concern was there is not a new catheter insertion of the second day.

Below is part of the response, we had used 01996 76000 in the past when they were going back in the OR the next day to do the bolus and using fluoro in addition but I was happy to receive the response as seen below 

it would be appropriate to report CPT code 01996. The CPT code for fluoroscopic guidance 77003 may be used but the carrier may ask for justification of medical necessity.


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## dwaldman (Aug 14, 2013)

When I re-read your question and thought you might also want to review this from AMA CPT Assistant. The procedure note does not indicate the place of service which can effect the code selection for the second day. But the reason I provided you the AMA CPT Network response I received, is I assume you are being asked by the provider why can the epidural code not be billed or you or other staff member is reviewing this. I had a similar situation but it was different then the scenario in an office setting below. In my scenario that I had presented this was in hospital setting with an overnight stay and the bolus on the second day. But note I pointed out there is not a new needle insertion/catheter insertion. I think this is the main reason they are saying use 01996. But if it is in an office setting see below

AMA CPT Assistant October 2012 page 14

Frequently Asked Questions:Anesthesia: Other Procedures

Question: We have a pain management provider that placed an epidural catheter in the office (62318) and now is doing a follow-up in the office. May the follow-up management be reported with code 01996? The descriptor references "hospital" management. 

Answer: No. Because the patient was discharged and seen in the office setting the next day, it would not be appropriate to report code 01996, Daily hospital management of epidural or subarachnoid continuous drug administration, as this code represents daily hospital management of a continuous epidural or subarachnoid drug infusion. Any follow up for a continuous epidural catheter placement reported by code 62318, Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substances(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic, in the office setting, would be reported with an appropriate level established patient, office or other outpatient evaluation and management service (E/M) code. If the follow-up service was performed on the same date as the catheter insertion, append modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service, to the appropriate level E/M code.


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## beatet66 (Aug 15, 2013)

Thanks for the response, to clarify, the scenario I provided is in the office setting.
So event though the provider is giving a separate bolus injection in addition to the ongoing infusion trial, he should only bill for the appropriate established patient ov charge?


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## dwaldman (Aug 15, 2013)

Yes, as per the AMA CPT Assistant published guidance, you would only report a follow up visit in an office setting.


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