Wiki Bundling of cpt 11981?

[zaidaaquino]

Although I don't see any NCCI edits that would disallow billing CPT 11981 when also billing CPT 24150, CPT 27365 or CPT 27487, Aetna is bundling this code into those three services. They are not allowing us to use -59 either. Is anyone else seeing this? At the end of the procedures, the doctor is inserting an ambulatory pain pump.

 

[shecodes]

They could be following AAOS instruction.

Global service data states the following is included in the surgical package: insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)

If the insertion of the catheter is inclusive, the only thing left to bill for would be the pain pump itself and that would typically not be billed by the provider.

AAOS FAQ #1

AAPC discussing post-operative pain management

Coding Clinic for HCPCS - Fourth Quarter 2002 Page: 8

Question
Following treatment for impingement syndrome of the right shoulder, a Zimmer pain pump catheter was placed into the shoulder for postoperative pain management. According to the operative report, the Zimmer pump catheter was placed into the shoulder and the muscle fascia was closed with a double layer suture.

What would be the appropriate code for the placement of the Zimmer pain pump?

Answer
The Zimmer pain pump is utilized for the infusion of local anesthetic directly into the surgical site for pain control. In this specific case, the Zimmer pain pump would be included in the procedure performed on the shoulder, and is not reported separately.

 

[KMCFADYEN]

Aetna uses McKesson for their edits.
To check the edits, you need to use Navinet to access the edits.
I have found that McKesson likes to add edits.

 

[CodingKing]

McKesson does custom edits that are not on the NCCI table. Payers can request payer specific edits, or reject the edits suggested.

 

[zaidaaquino]

Yes, I checked on NaviNet because I know they have their own edits as well. But their "explanation" of the denial is not sufficient. I wanted to see if there was an actual guideline for this. But I appreciate everyone's comments.