General Surgery Coding Alert

Question: Our surgeon inserted a paraspinal On-Q pump for pain control for multiple rib fractures. We've been told to report 21800 for each rib. But the surgeon placed the pump in the area to cover multilevel rib fractures, so I'm thinking 62350 is more appropriate -- what do you think?

Minnesota Subscriber

Answer: You'll need to follow payer guidelines -- which may not match manufacturer billing advice -- for the On-Q pain pump. Many payers will not pay separately for inserting the pump because the work is nominal and they consider it part of the surgical procedure.

Although 21800 (Closed treatment of rib fracture, uncomplicated, each) would be appropriate for the reduction, which might include pain pump placement, using the code for the pain pump alone would not be appropriate.

Nor should you report 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).

The procedure you describe is not a tunneled catheter.

Options: If your payer will consider separate payment for the On-Q, you might want to report 64421 (Injection, anesthetic agent; intercostal nerves, multiple, regional block) or 64999 (Unlisted procedure, nervous system) for the service in addition to the code for the primary service.

Bottom line: Don't be surprised if payers bundle the pain pump into the fracture reduction. Work with payers for appropriate code selection if they allow you to bill separately for the work.