Orthopedic Coding Alert

While CPT has several codes for the placement of subcutaneous, long-term pain pumps, none exists for a short-term, external pump. The closest match is 90799 (unlisted therapeutic, prophylactic or diagnostic injection) because the pump is a means of injecting medication through a catheter. But short-term pain pumps inserted at the time of surgery are not a reimbursable service. Any potential CPT codes for pump insertion (in this case, 90799) are bundled in with the primary surgical procedure. Per the American Association of Orthopedic Surgeons (AAOS) Complete Global Service Data for Orthopedic Surgery, the insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), catheter(s), or suction device(s) are included in virtually every major orthopedic surgery.

In orthopedics, pain pumps are most often administered at the time of major surgery. The newer models of pain pumps are external devices that deliver anesthetic through a catheter directly to the surgical site, rather than intravenously as with older models. Proponents of pain pumps say the pump allows for the patient to be discharged earlier, in a more alert state with less pain. Temporary pumps are most often used for shoulder surgeries, during rotator cuff repairs (e.g., 23412, repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic). The pump is inserted for about two days, and infuses anesthetic to the affected area for postsurgical pain management.

Because the majority of work involved in fitting a patient with a pain pump is the catheterization, it is not separately billable. Although the AAOS guidelines for bundling do not necessarily match those of commercial carriers, they are widely accepted as authoritative, and most commercial carriers will either follow the AAOS or Medicare guidelines, or have guidelines of their own that are even more restrictive.

For Medicare patients, the use of temporary pain pumps following surgery is deemed not medically necessary. Medicare considers the placement of a catheter at the operative site for pain management to be a part of the primary procedure and does not reimburse separately for it, says BillieJo McCrary, CPC, CCS-P, CMPC, practice manager of Wellington Orthopedic and Sports Medicine in Cincinnati. I am aware that some physicians have billed inappropriately using 62360, 62361 and 62362 (implantation or replacement of device for intrathecal or epidural drug infusion ...) to describe the placement of a subcutaneous catheter attached to a pump to administer a controlled release of pain medication to the operative site, but these are not codes for short-term pain-management pumps, she says.

Be Cautious With Supplier Recommendations

According to many orthopedic coders, suppliers of pain-infusion pumps have encouraged physicians and staff that inserting the pumps is billable but, in virtually all cases, it is not. Several have been instructed by [...]