Anesthesia Coding Alert

The three-stage process of using a permanent implantable pump (trial insertion and evaluation, permanent placement, and ongoing maintenance) can present a significant coding dilemma for anesthesia practices. The challenge is that how each stage is performed largely determines how the next one is coded.
 
Clearing Up Trial-pump Coding (Stage One)
 
"During a trial, you're trying to demonstrate that the implantable pump (intrathecal or infusion) is the way to go for a patient," explains Abraham Rivera, MD, CEO of the Pain Management Medical Group in Albany, N.Y. "To clearly show that, you have to prove to yourself that the patient has had at least 50 percent reduction in pain that cannot be achieved with oral medications or any other means. You prove that you're on the right track by showing that the patient's pain scores came down 50 percent, and that the oral medication was cut by 50 percent during the trial-pump usage."
A trial can be done three different ways: single injection of medication, continuous infusion, or tunneled catheter with external pump. "I think the confusion starts primarily with billing a trial," says Devona Slater, CMCP, president of Auditing for Compliance and Education Inc., a consulting firm in Leawood, Kan., that focuses on physician compliance plans in anesthesia and pain management. "The correct code for permanent placement, and whether modifiers must be appended, depends on how the trial is coded." 
The length of a trial period is determined by the physician and the patient's clinical condition, Slater says. She explains that a single-shot trial period could be one day, a continuous infusion trial two or three days, and a trial with the catheter tunneled with an external pump three days to two weeks.   1. Single injection of medication (or single-shot) trial: According to Rivera, you can do a trial by just performing a single-shot intraspinal morphine injection and observing the patient for 24 hours. However, Rivera says, a 24-hour trial period might not truly reflect the patient's pain situation. If the anesthesiologist decides on this trial method, depending on the location of the injection, code the procedure with CPT 62310 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or CPT 62311 (... lumbar, sacral [caudal]. 
 
2. Continuous infusion: "The next best thing to a single injection is to place a temporary intraspinal catheter over three to five days and slowly infuse morphine, reproducing what the actual pump would do," he adds. Some physicians choose longer trial periods, allowing the patient to return home with the trial pump in order to acquire a [...]