Anesthesia Coding Alert

Question: When billing code 96530, is there an anesthesia unit charge for, say, three units?
                                                                                      
Texas Subscriber

Answer: No anesthesia charges are involved, because this is a pain management procedure, says Amy Mowles, CEO of Mowles Medical Practice Management, a nationally recognized speaker on pain management.
 
It is very easy to confuse anesthesia and pain management, particularly because often anesthesiologists also are pain management physicians. But unlike anesthesiologists, the pain management physician provides services and performs procedures like other surgeons, using surgical or medicine CPT codes rather than anesthesiology codes.
 
Therefore, there are no unit charges when billing 96530 (refilling and maintenance of implantable pump or reservoir). However, Mowles cautions that Medicare and many commercial carriers only will reimburse this procedure when performed in the office (place of service 11). According to Medicare, if the service is provided in the outpatient hospital setting or an ambulatory surgical center (ASC) (place of service 22 and 24, respectively), it will likely be denied. The reason: Medicare considers this to be a nursing service. Because the hospital and ASC are already getting paid a facility fee for their nurses, Medicare will not pay for such a service a second time. Additionally, Medicare includes the pump refill kit in 96530, therefore A4420 (refill kit for implantable infusion pump) should not be billed separately, Mowles says. However, she adds, the drugs used may be charged separately.