Anesthesia Coding Alert

On top of dealing with the dread diagnosis of cancer and all of its ramifications, many cancer patients have pain caused by the cancer itself and also by cancer treatments. Increasingly, cancer patients are turning to pain management specialists for relief. For pain management coders and billers, this means that an understanding of the treatment procedures for cancer pain and the claim requirements of Medicare and private carriers is a must to ensure optimal reimbursement. Lynne Carr Columbus, DO, of Gulf Coast Pain Management in Palm Harbor, Fla., says, "While cancer pain is normally associated with the advanced stages of the illness, pain can occur for many reasons throughout the progression of the disease. These reasons include a tumor pressing on nerves or bone metastasis; treatment procedures, such as chemotherapy, radiation, or surgery; or pre-existing conditions, such as arthritis or diabetes. Invasive diagnostic and therapeutic procedures, including lumbar punctures and bone marrow biopsies, may also result in pain."

While Columbus is careful to point out that there are numerous treatment options for patients with cancer-related pain, one such method is intrathecal pain therapy. Columbus notes that the World Health Organization (WHO) has outlined an "analgesic ladder" whereby increasingly severe pain is treated with increasingly potent analgesics.

"The three rungs of this ladder include nonopioids for mild pain, weak opioids for moderate pain, and potent opioids for severe pain." Patients undergoing chemotherapy or radiation may not tolerate oral, transdermal, or rectal medication, due to the side effects of the chemotherapy (such as nausea, vomiting, constipation, or drowsiness). In these instances, or when the patient is not responding to more conservative therapies, Columbus says that interventional techniques, such as intrathecal pain therapy, are an effective means to manage the patient's pain. Coding Guidelines for Intrathecal Administration Intrathecal pain therapy involves the placement of a pain pump directly under the skin of the abdomen. Through an indwelling catheter, the pump directs controlled doses of analgesia directly to the site of action in the spine. Columbus says that this form of therapy is very effective for patients who have exhausted more conservative forms of therapy. She also adds, "Studies have shown that the use of intrathecal narcotics can yield fewer side effects and complications than traditional therapy."

CPT Codes 2002 provides the following codes related to the placement and maintenance of the catheter and pain pump:

62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy

62351 with laminectomy 62355 Removal of previously implanted intra-thecal or epidural catheter

62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir

62361 ... non-programmable pump [...]