Neurosurgery Coding Alert

Question: Is there any way to code for nonepidural continuous infusion pump placements? Our neurosurgeon has to use these from time to time, but I don't know if the insurers pay separately for them.


Minnesota Subscriber


Answer: You may be able to code the infusion separately, but certain payers do not consider the service payable, so you-ll have to do some research before reporting -pain pump- placement.

The basics: Continuous infusion pumps provide a steady stream of local anesthetic to an area singled out for pain relief. When your neurosurgeon treats a patient with a pain pump, choose from the following codes:

- Use 64416 (Injection, anesthetic agent; brachial plexus, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) if the neurosurgeon targets the brachial plexus with the infusion.

- Use 64446 (... sciatic nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) if the neurosurgeon targets the sciatic nerve with the infusion.

- Use 64448 (... femoral nerve, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) if the neurosurgeon targets the femoral nerve with the infusion.

- Use 64449 (... lumbar plexus, posterior approach, continuous infusion by catheter [including catheter placement] including daily management for anesthetic agent administration) if the neurosurgeon targets the lumbar plexus with the infusion.

ABN alert: Many payers, both private and federal, will not reimburse for the pain pump codes, citing a lack of evidence that they are effective. If you are placing one of these pumps in a patient, get him to sign an advance beneficiary notice (ABN). The ABN should explain to the patient that the payer may not cover the pain pump placement, and the patient will have to pick up any portion of the service left unpaid.