Wiki Exparel coding in ASC

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pchamp25

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New Durham, NH
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ASC located in the northeast and I was wondering if anyone has billed out for Exparel? This is a new drug used for pain, instead of narcotics and the procedure code is C9290. If anyone has billed this out, is anyone having trouble getting it approved any certain insurance companies? Has anyone been able to overturn the initial denials and if so how? We have been able to get some insurances to process and pay but not all. Thanks for the help in advance!
 
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SharonCollachi said:
Are you getting it pre-authorized, or trying to get it paid afterwards? Did you reach out to Pacira for help?
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We are not getting it pre-authorized as it is part of the anesthesia process, we actually have never tried to see if it even needed an auth. I will say that the denial reasons we have received were not because no PA was on file. We have also followed up w/Pacira but they are not great on getting back to us in a reasonable timeframe or even with the answers we are looking for. The biggest insurance companies we are having trouble getting payments from are Aetna, Anthem, and Tufts
 
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pchamp25 said:
We are not getting it pre-authorized as it is part of the anesthesia process, we actually have never tried to see if it even needed an auth. I will say that the denial reasons we have received were not because no PA was on file. We have also followed up w/Pacira but they are not great on getting back to us in a reasonable timeframe or even with the answers we are looking for. The biggest insurance companies we are having trouble getting payments from are Aetna, Anthem, and Tufts
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I don't bill for ASC for facility; I have billed for MD at ASC, and for procedures in the office (when we used to have a procedure room setup).

So this is an extended-release bupivicaine. And it's a relatively new drug. The code for it is a C-code. Do you normally get paid for "caine" drugs in the ASC? In the office setting, we don't get paid for caine drugs, it's part of the procedure.
 
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SharonCollachi said:
I don't bill for ASC for facility; I have billed for MD at ASC, and for procedures in the office (when we used to have a procedure room setup).

So this is an extended-release bupivicaine. And it's a relatively new drug. The code for it is a C-code. Do you normally get paid for "caine" drugs in the ASC? In the office setting, we don't get paid for caine drugs, it's part of the procedure.
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I am new to this facility (and coding in general) but we had a meeting today and I was advised it is not part of the procedure, it is separate. We also know it is relatively new and that is why I was reaching out to see if anyone else has tried billing for it and if so if they have had any issues. Our rep from Pacira like I said has not been quick on getting us the help we need but he is trying. Any additional help would be great!
 
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