Pain Pumps:
Coding Tactics to Get Paid
Published on Thu Mar 01, 2001
Through documenting the ineffectiveness of other pain management and spacticity treatments and choosing appropriate procedure and diagnosis codes for pain pumps (62350-62368), neurosurgeons may overturn denials and eliminate the risk of future lost reimbursement.
Document Medical Necessity
Proper documentation is the first thing Medicare and most third-party payers look for when reviewing claims for pain pumps, says Tamara Middleton, CCS-P, an analyst specialist for the centralized abstracting unit at the University of California at Davis in Sacramento who is in charge of physician billing for the hospitals six neurosurgeons, In addition to detailed operative notes, HCFA requires the documentation of the following:
1. Pain Control. For opioid drugs (e.g., morphine) administered, document that the treatment is for severe, chronic intractable pain of malignant or nonmalignant origin for patients with a life expectancy of at least three months who have proven unresponsive to less invasive medical therapy by including the following:
Specific indication in the patients history that he or she has not responded to noninvasive methods of pain control such as a systemic opioid (including attempts to eliminate physical and behavioral abnormalities that may cause an exaggerated reaction to pain).
A record of a preliminary trial of intraspinal opioid drug administration with a temporary intrathecal/epidural catheter to substantiate acceptable pain relief and degree of side effects (including effects on the activities of daily living) and patient acceptance.
2. Spasticity treatment. For administration of antispasmodic drugs (e.g., baclofen) document evidence that the patient was unresponsive to less invasive medical therapy by including:
Notation of a trial period of at least six weeks during which it is proven that the patient cannot be maintained on noninvasive methods of spasm control such as oral antispasmodic drugs because these methods either failed to control the spasticity or produced intolerable side effects.
Commentary that prior to pump implantation, the patient responded favorably to a trial intrathecal dose of the antispasmodic drug.
Note: Occasionally, the surgeon will implant just the catheter in order to carry out this trial. If the pump is then implanted after a successful trial, the placement may be considered a prospectively planned staged procedure, and can be billed with the -58 modifier.
Procedure and Modifier Coding Tips
Neurosurgical coders most often face potential denials or lost revenue due to incorrect procedural coding in four key areas:
1. Implantation of catheter and pump. Coding 62362 (implantation or replacement of device for intrathecal or epidural drug infusion) and 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) appended with -51(multiple procedures) is recommended by Beverly Trout, coding and reimbursement specialist for Associated University Neurosurgeons in [...]
