Neurology & Pain Management Coding Alert

Include daily drug management in your injection service

When reporting so-called "pain pumps" for pain relief, your codes of choice are 64416, 64446, 64448 and 64449. 

Because many payers think these devices do not meet medical-necessity requirements, however, you might want to ask patients to complete an advance beneficiary notice (ABN) prior to providing the service to protect your reimbursement. Choose Code by Nerve Targeted The most important piece of information you must have before choosing a pain pump code is: Which nerve is the physician targeting?

If the neurologist is targeting the brachial plexus, choose:

64416 - Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration. For the sciatic nerve, choose: 64446 - ... sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration. If the pain pump targets the femoral nerve, choose:

64448 - ... femoral nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration.  For the pain control at the lumbar plexus, choose:
64449 - ... lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration. Avoid 01996 With Pain Pumps You shouldn't report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) with 64416, 64446, 64448 and 64449, CPT guidelines stipulate.

"According to the American Society of Anesthesiologist's guide, code 64416 includes management days with a 10-day global period," says Kim Arnett, CPC, coderfor Georgia Anesthesiologists PC, in Marietta. In addition, the descriptors for 64416-64449 specify "including daily management for anesthetic agent administration." Check With Your Payer Before filing a claim, contact your payer to see if they will cover continuous infusion pumps for pain relief. You may find that many insurers consider these devices investigational and/or medically unnecessary.

Example: Aetna - which provides medical coverage for over 14 million beneficiaries nationwide - "considers infusion pumps for intralesional administration of narcotic analgesics and anesthetics experimental and investigational because the effectiveness of these pumps has not been demonstrated in well-designed clinical studies in the peer-reviewed published medical literature."
 
Furthermore, Aetna won't cover infusion pumps for intra-articular administration of narcotic analgesics and anesthetics either, claiming that these devices are "experimental and investigational because they have not been proven to improve postoperative pain control." Protect Reimbursement With an ABN To be sure you can recover some reimbursement for the neurologist's effort in placing a continuous infusion pain pump, you should ask the patient to sign an ABN.

The patient must sign the ABN prior to receiving the service. Of course, the patient may choose to forego treatment, but at least he will know that if he chooses to receive the treatment, he may be [...]