Neurosurgery Coding Alert

Question: How should I report pain pump application following surgery?

North Carolina Subscriber

Answer: In many cases, you shouldn't report pain pump application separately. Instead, you should consider it part of the global surgical fee.

Most insurers- computer programs screen claims for pain pump insertion and deny the service if the practice bills the insertion with a surgical procedure.

For instance, CIGNA, a Part B Medicare carrier in Idaho, North Carolina and Tennessee, publishes a policy that states that surgical wound catheters for postoperative pain control are now "being used in a wide variety of surgeries ... No existing codes apply to this service, and CPT codes such as 11981 or codes from the 64400-64449 series cannot be used for this service."

CIGNA's policy also reminds coders that "Leaving a catheter behind in the operative field is considered a component of the surgical procedure and not separately payable by Medicare. It is important to also note that the control of pain is generally included in the global surgical package as part of postoperative care."

Important exception: In most cases, you can still collect payment when the surgeon implants a pain pump at the patient's spine for chronic pain conditions. Insurers evaluate such pain pump implantations against very stringent guidelines, but they often cover the service for conditions such as failed back syndrome or arthritis.

Explanation: The spine procedure is far more delicate surgery than the extremity pump insertion and often requires a separate procedure simply to insert the pump.

Insurers frequently require documentation that demonstrates your surgeon's prior attempts to alleviate the patient's pain and proof of the patient's loss of ability before they will pay you for implanted spinal pain pumps. If your patient meets the insurers- guidelines, you should report one of the following codes for the work of implanting the spinal pain pump: