Medical Necessity Key to Optimize Pay Up for Pain Pumps
Published on Tue Feb 01, 2000
Pain pumps often are used to manage a patients pain after spine surgery, but getting reimbursed for the procedures and extra work involved may be challenging. By documenting the ineffectiveness of other pain management attempts and establishing the medical necessity for the pump, neurosurgeons can decrease the chances for denials.
For example, a patient undergoes an extensive spine surgery and experiences severe postoperative pain. Standard medications are ineffective for treating her discomfort, and she does not respond to multiple injections of stronger substances for pain management. The neurosurgeon decides that a programmable pain pump must be installed to address her condition. The pump is implanted and successfully controls the patients pain.
Douglas Rammel, MHCM, chief executive officer of Associated University Neurosurgeons, Peoria, Ill., a seven-member neurosurgery group that installs as many as 10 pain pumps each year, says that one of the main reasons for denials is a lack of documentation that all other avenues of pain management have been tried and proven to be ineffective. Thats the first thing Medicare and most third-party payers will look for; the physician has to prove the medical necessity, says Rammel.
Beverly Trout, coding and reimbursement specialist for Associated University Neurosurgeons, says that patients ultimately requiring the implantation of a drug infusion pump present with a variety of chronic pain symptoms. Cancer patients, sufferers of nerve damage or nerve entrapment, or patients like the one described above, all meet the requirement of having chronic pain that does not respond to normal mechanisms of pain treatment.
The patients specific pain management needs determine the type of drug necessary for treatment, and the choice of a pump is made based on that information. For example, a morphine pump may be used with a cancer sufferer, while a baclofen pump would be more appropriate for spasticity.
Coding Pain Pump Implantation
Trout says that a typical coding scenario for the implantation of a pain pump will begin with code 62350 (implantation, revision, or repositioning of tunneled intrathecal or epidural catheter, for long-term pain management via an external pump or implantable reservoir/infusion pump; without laminectomy) for the percutaneous implantation. The catheter portion also may be implanted by laminectomy (62351).
Implantation of the actual pump is then coded. There are three different codes for implantation of pain pumps:
62360implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir) for subcutaneous reservoir
62361implantation or replacement of device for intrathecal or epidural drug infusion; non-programmable pump) for a non-programmable pump
62362implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming) for programmable pumps.
Associated University Neurosurgeons generally uses [...]
