Neurosurgery Coding Alert

Payers may refuse coverage, so ask the patient to sign an ABN

If you're looking for the codes to describe so-called "pain pumps" for pain relief, you should turn to 64416, 64446 and 64448. Be aware, however, that many payers feel these devices do not meet medical-necessity requirements. 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 surgeon 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, look to:
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, select:
64449 - ... lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration. Avoid 01996 With Pain Pumps Just in case you are tempted, you shouldn't report 01996 (Daily hospital management of epidural or subarachnoid continuous drug administration) with 64416, 64446, 64448 and 64449, according to CPT guidelines.

"According to the American Society of Anesthesiologist's guide, code 64416 includes management days with a 10-day global period," says Kim Arnett, CPC, coder for Georgia Anesthesiologists PC, in Marietta. In addition, the descriptors for 64416-64449 specify "including daily management for anesthetic agent administration." That means you shouldn't code management days separately.

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 be disappointed to 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 that you can recover some reimbursement for the surgeon'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 [...]