Orthopedic Coding Alert

Question: Our surgeon performs multi-level posterior and anterior spinal fusion surgeries for scoliosis and he places an epidural catheter for pain management after surgery. Can we bill for the pain catheter insertion? 


Nebraska Subscriber

Answer: You should follow the same rules for spinal pain catheters as you would for shoulder and knee catheters: Include the surgeon's work implanting the pump in the global fee for the main surgery.

The American Academy of Orthopaedic Surgeons (AAOS) established a general guideline for orthopedic procedures that states, -Insertion of a catheter is part of the global surgical package. The pump itself may be coded using a HCPCS code.- This information is available on the Frequently Asked Questions section of the AAOS- Practice Management Web site.

Rationale: The patient's spine is already exposed during the scoliosis procedure, so the surgeon doesn't have to exert much additional effort to insert the pump.

CIGNA, a Part B Medicare carrier in multiple states, publishes a policy that says, -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.-

For more information on pain catheter insertions, see our June 2005 article -Include Pain Pump Insertions in Knee, Shoulder Surgeries.-