Neurology & Pain Management Coding Alert

For the sciatic nerve, choose:

If the pain pump targets the femoral nerve, choose:

64448 - ... femoral nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration.

 For the pain control at the lumbar plexus, choose:

Avoid 01996 With Pain Pumps

You shouldn't report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) with 64416, 64446, 64448 and 64449, CPT guidelines stipulate.

"According to the American Society of Anesthesiologist's guide, code 64416 includes management days with a 10-day global period," says Kim Arnett, CPC, coderfor Georgia Anesthesiologists PC, in Marietta. In addition, the descriptors for 64416-64449 specify "including daily management for anesthetic agent administration."

Check With Your Payer

Before filing a claim, contact your payer to see if they will cover continuous infusion pumps for pain relief. You may find that many insurers consider these devices investigational and/or medically unnecessary.

Example: Aetna - which provides medical coverage for over 14 million beneficiaries nationwide - "considers infusion pumps for intralesional administration of narcotic analgesics and anesthetics experimental and investigational because the effectiveness of these pumps has not been demonstrated in well-designed clinical studies in the peer-reviewed published medical literature."
 
Furthermore, Aetna won't cover infusion pumps for intra-articular administration of narcotic analgesics and anesthetics either, claiming that these devices are "experimental and investigational because they have not been proven to improve postoperative pain control."

Protect Reimbursement With an ABN

To be sure you can recover some reimbursement for the neurologist's effort in placing a continuous infusion pain pump, you should ask the patient to sign an ABN.

The patient must sign the ABN prior to receiving the service. Of course, the patient may choose to forego treatment, but at least he will know that if he chooses to receive the treatment, he may be responsible for payment if the insurer will not allow coverage.

Medicare does not mandate that you use ABNs, but it does prohibit billing a Medicare beneficiary for a denied claim unless the doctor's office has a signed ABN on file. This regulation doesn't apply to commercial payers, but an ABN is a courtesy to patients and helps them make financial arrangements before services are provided, rather than after.

"If you don't have an ABN and Medicare refuses the claim, you're pretty much out the money," says Kathryn Cianciolo, RHIA, CCS, CCS-P, a Waukesha, Wis., coding consultant for more than 20 years. "You're not allowed to bill the patient for it."

With a signed ABN on file, however, your office is justified in billing the patient for any part of the bill Medicare won't pay for. The ABN proves to Medicare that the patient understood that he might be responsible for the bill before the procedure was performed, Cianciolo says.

Learn more: For more information on advance beneficiary notices, see "Don't Give Up Payment for Non-covered Procedures" and "The ABCs of ABNs," Neurology Coding Alert, May 2004.