Anesthesia Coding Alert

Question: How should we code spinal pump insertion for pain management? Our physician helped with the procedure but didn't perform the actual insertion. Florida Subscriber Answer: First, know that your pain physician cannot bill for the insertion because he didn't personally perform it -- but you can bill for the pump and possibly the medication in it. The challenge, however, comes with reporting the pump because coders and insurance carriers have different viewpoints. Options you might see include: • A4306 -- Disposable drug delivery system, flow rate of less than 50 ml per hour • E0782 -- Infusion pump, implantable, nonprogrammable (includes all components, e.g., pump, catheter, connectors, etc.) • L8699 -- Prosthetic implant, not otherwise specified. Note: Many anesthesiologists are trained to insert pain pumps. If your physician has this training and inserts the pump instead of only managing it, you can bill the insertion. Check codes 62360-62362 (Implantation or replacement of device for intrathecal or epidural drug infusion ...) to see which applies to the situation. Because the pump insertion is a surgical procedure, the hospital might bill the medication. If your physician supplies the medication, however, you can report the appropriate J code for it. Because of the varying options, check your payer's guidelines and talk with your physician before submitting the claim. -- Answers to You Be the Coder and Reader Questions were provided by Scott Groudine, MD, an Albany, N.Y., anesthesiologist; Barbara J. Johnson, CPC, MPC, owner of Real Code Inc. in Moreno Valley, Calif.; and Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.