Neurosurgery Coding Alert

Question: Our physician assistant (PA) traveled to a patients home to refill his pain pump. The trip took four hours by car. An exam was performed, and the pain pump was refilled. The medication was transported by the PA. How can I get reimbursed for the travel from a workers compensation carrier?

Wisconsin Subscriber

Answer: There are several issues related to medical necessity that the insurance carrier, in this case workers compensation, will consider. The first is the reason why the patient cannot come to the office for the refill. If the patient can come to the office, then the PA should not have gone to his home. Second, the PA had to travel far: (i.e., was he or she the closest professional available?) If not, then reimbursement will not be made. Third, this situation should have been explained to the carrier ahead of time, and pre-approved.

As far as what codes to bill for the travel expenses, you could try to use 99082 (unusual travel [e.g., transportation and escort of patient]). Workers compensation should pay if your PA was the closest and the patient could not come to the office. You should also submit the PAs documentation including everything that he did with the patient and how long the travel took, as well as how long he spent with the patient to conduct the exam and refill the pump. Even if you cannot get paid for the travel, the pain pump refill should be coded as 96530.