General Surgery Coding Alert

Question: What is the correct code for placement of an ON-Q pain pump for post-procedure pain management? I-ve been using 49999, but no payer will recognize this.


North Carolina Subscriber

Answer: For most payers, you cannot charge separately for placement of the ON-Q pain pump using an unlisted- procedure code such as 49999 (Unlisted procedure, abdomen, peritoneum and omentum), or any other code.

The ON-Q pain pump is a recently introduced 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.
 
Chapter 1 of the National Correct Coding Initiative clearly states, -insertion and removal of drains, suction devices, dressings, [and] pumps- into the same site as the primary procedure are -generic services integral to standards of medical/surgical services.- In other words, such services are not separately reportable or payable.

Local Medicare payers, such as Blue Cross/Blue Shield of North Carolina, provide specific local coverage determinations that explain, for instance, -Payment for catheter insertion and removal to provide continuous delivery of a drug to a surgical site is included in the allowance for the surgery and, therefore, is not eligible for separate payment.-

If your surgeon supplies the pump that he implants, you may be able to bill for this supply using HCPCS codes A4305 (Disposable drug delivery system, flow rate of 50 ml or greater per hour) or A4306 (... flow rate of 5 ml or less per hour). Note, however, that many payers consider these pumps to be investigational and -unproven,- and therefore may not reimburse for any portion of the service.