peporter
Guru
I have been having trouble getting payors to process pain pump insertion codes for the surgeon. Any suggestions?
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Wiki pain pump insertion
- Thread starter peporter
- Start date
RebeccaWoodward*
True Blue
What code(s) are your filing? We're not experiencing any issues.
https://www.noridianmedicare.com/sh...Pumps_and_Covered_Diagnoses_(Part_2_of_3).htm
I know this is part 2 of 3 but it still has some very good information.
https://www.noridianmedicare.com/sh...Pumps_and_Covered_Diagnoses_(Part_2_of_3).htm
I know this is part 2 of 3 but it still has some very good information.
mbort
True Blue
Pain Pumps for Orthopedic surgery is not usually seperately reported. Please see documentation below:
Orthopedic Coders Pink Sheet January 2007 (send me a private message with your fax # if you need the page--I have it posted on my office wall to remind my docs)
and from the Coding Institute:
ON-Q Pump Placement Isn't Separate
Question: What is the correct code for placement of
an ON-Q pain pump for postprocedure pain management?
I've tried several codes, including unlisted-procedure
codes, without success.
North Carolina Subscriber
Answer: For most payers, you cannot charge separately for placement of the
ON-Q pain pump using an unlisted-procedure code such as 49999 (Unlisted
procedure, abdomen, peritoneum and omentum), or any other code for that matter.
The ON-Q pain pump is a relatively new type of patient-controlled, temporary
pump, similar to patient-controlled analgesia (PCA). It provides continuous infusion
of a local anesthetic directly into the operative site for post-op pain management.
Chapter 1 of the national Correct Coding Initiative (CCI) clearly states,
“insertion and removal of drains, suction devices, dressings, [and] pumps” into the
same site as the primary procedure are “generic services integral to standards of
medical/surgical services.” In other words, such services are not separately
reportable or payable.
Local Medicare payers, such as Blue Cross/Blue Shield in North Carolina,
provide specific local coverage determinations that explain, for instance, “Payment
for catheter insertion and removal to provide continuous delivery of a drug to a
surgical site is included in the allowance for the surgery and, therefore, is not
eligible for separate payment.”
Your facility may be able to bill for this supply using HCPCS codes A4305
(Disposable drug delivery system, flow rate of 50 ml or greater per hour) or A4306
(... flow rate of less than 50 ml per hour), depending on payer guidelines. But many
payers consider these pumps to be investigational and “unproven,” and therefore
may not reimburse for any portion of the service.
,
Orthopedic Coders Pink Sheet January 2007 (send me a private message with your fax # if you need the page--I have it posted on my office wall to remind my docs)
and from the Coding Institute:
ON-Q Pump Placement Isn't Separate
Question: What is the correct code for placement of
an ON-Q pain pump for postprocedure pain management?
I've tried several codes, including unlisted-procedure
codes, without success.
North Carolina Subscriber
Answer: For most payers, you cannot charge separately for placement of the
ON-Q pain pump using an unlisted-procedure code such as 49999 (Unlisted
procedure, abdomen, peritoneum and omentum), or any other code for that matter.
The ON-Q pain pump is a relatively new type of patient-controlled, temporary
pump, similar to patient-controlled analgesia (PCA). It provides continuous infusion
of a local anesthetic directly into the operative site for post-op pain management.
Chapter 1 of the national Correct Coding Initiative (CCI) clearly states,
“insertion and removal of drains, suction devices, dressings, [and] pumps” into the
same site as the primary procedure are “generic services integral to standards of
medical/surgical services.” In other words, such services are not separately
reportable or payable.
Local Medicare payers, such as Blue Cross/Blue Shield in North Carolina,
provide specific local coverage determinations that explain, for instance, “Payment
for catheter insertion and removal to provide continuous delivery of a drug to a
surgical site is included in the allowance for the surgery and, therefore, is not
eligible for separate payment.”
Your facility may be able to bill for this supply using HCPCS codes A4305
(Disposable drug delivery system, flow rate of 50 ml or greater per hour) or A4306
(... flow rate of less than 50 ml per hour), depending on payer guidelines. But many
payers consider these pumps to be investigational and “unproven,” and therefore
may not reimburse for any portion of the service.
,
peporter
Guru
In regard to the codes being used. I am billing pain pumps using the unlisted 27599 and 23929 as the surgeons use the pumps mainly for knee and shoulder surgeries. Thanks to everyone for the help, Paula
RebeccaWoodward*
True Blue
I do stand corrected. I did not read the question closely enough. Mary...as always, thank you for for this reference.