ASC Posts $800 a Pop for Pain Pumps

Medicare and most carriers don’t reimburse surgical facilities for pain pumps, except at Northwest Ambulatory Surgery Center in Portland, Ore.

Medicare does not consider pain pumps a separately billable service. It’s included in the post-op pain management and part of the surgery/anesthesia. So how does Northwest Ambulatory Surgery Center get paid and profit from them? On average, Northwest Ambulatory Surgery Center earns about $800 for every continuous nerve block they do. According to Outpatient Surgery, March 2012, “Some private insurers follow Medicare’s guidelines in not paying for pumps, but other carriers, including some workers’ compensation firms, let you bill for CPT codes 64416 (Shoulder, catheter/pain pump placement) and 64448 (Knee, catheter/pain pump placement).”

CPB : Online Medical Billing Course

If continuous nerve blocks and pain pumps are a standard of care at your facility and your payers aren’t paying you, here are some reimbursement tips:

  • Renegotiate contracts and ask for specifics on how to submit claims.
  • Document the pump’s placement separately.
  • Ask the payer whether to bill under the surgeon’s or the anesthesia provider’s name because it is usually considered a second procedure.
  • Appeal unpaid claims and be persistent.
  • Explain to the payer that these services get patients out of recovery quickly and keep them out of the hospital, which reduces care costs.
  • Explain to the payer that other insurance pays for this service and because your facility is performing a service you should get paid for it.

Source: Kecia Rardin, RN, CNOR, CASC, “Get Paid for Pain Pumps,” Outpatient Surgery, March 2012


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2 Responses to “ASC Posts $800 a Pop for Pain Pumps”

  1. Mary Lagerquist says:

    The use of the codes 64416 os 64448 is very misleading since nowhere in the CPT code does it state …catheter/pain pump placement.

  2. Jeremy Reimer says:

    Not sure about this one…

    From what I understand, CCI edits bundle 64416 into most ortho/musculoskeletal codes (20000’s).

    Also, as the article states, CMS’s global surgery package includes postoperative pain management when conducted by the physician performing the surgical procedure.

    Now, if the physician performing surgery doesn’t have the skills or experience to manage the post-op pain mgmt, the surgeon could request that an anesthesiologist perform the post-op pain management. In this case, it’s my belief that the anesthesiologist could report the additional services.

    Here is where I think things get tricky- If the anesthesiologist places a catheter for continuous infusion or nerve block for intraoperative pain management, wouldn’t this service is included in the 0XXXX anesthesia code and not be separately reportable, even if the pump is also used for post-op pain mgmt?

    My point is- if the anesthesiologist bills a 0XXXX code for his professional services during the surgery, could he/she also bill for the post-op pump? It would seem to me that this would be included in the original anesthesia code.

    Perhaps there is a reason that Medicare will not pay for this, and considers it unbundling to report 644416/64448 separately. I’m not so sure that saying, “Northwest Ambulatory Surgery Center in Portland, Oregon uses it all the time” will be a sufficient explanation in the case of an audit.

    Just my thoughts…..

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