Anesthesia Coding Alert

Question: What code should I report for the new On-Q pain pump?

Michigan Subscriber

Answer: The On-Q pain pump is a new type of patient-controlled, temporary pump, similar to patient- controlled analgesia (PCA). It provides continuous infusion of a local anesthetic directly into the operative site for post-op pain management. Some coders believe its insertion is simple enough to be included with the surgical anesthesia fee; others say you could possibly report 64999 (Unlisted procedure, nervous system) with documentation to explain the procedure.
 
Before writing off your chance for reimbursement, verify whether the physician used an On-Q C-bloc system instead. This system administers regional anesthesia to a particular site for post-op pain relief. It allows patients to have both continuous and on-demand pain relief. Codes for it include 64446 (Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter [including catheter placement], including daily management for anesthetic agent administration), 64448 (... femoral nerve, continuous infusion by catheter [including catheter placement], including daily management for anesthetic agent administration) and 64416 (... brachial plexus, continuous infusion by catheter [including catheter placement], including daily management for anesthetic agent administration).