Wiki ON-Q Pain Pump

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valariej

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One of our docs is considering using the ON-Q Pain Pump.

Do any of you have experience in billing for this? Are you using catheter placement codes or unlisted codes with notes?

Any comments are appreciated.

Thank you!
 
A lot of my physicians do this. Medicare considers it bundled. Some private insurers pay, it's pretty hit or miss. It's billed with an unlisted code and you'd have to provide documentation.
 
I e-mailed MedStaff Plus and was told this: "Medicare, Medicaid and BCBS do not reimburse separately for the placement procedure - they consider their payment on the primary procedure to include this as well" I tried it on a few for each different insurance and got denials. I even tried to send documentation and a sample letter that an On-Q rep gave me and had no luck. I did have a couple of commerical insurances pay on this. I was using the unlisted 49999.
 
I actually have info from the company here on how to bill and it does say to use the 49999 w/ mod 59 and 79 and dx of pain by site of placement and 338.18 (post-op pain). most offices billed based on national average reimbursement between $50-200. (WC often pays $500) It's recommend to get a pre-cert. and Medicare and Medicaid do not allow additional reimbursement for this procedure. But again, I found it more of a hassel then it was worth.
 
I realize you probably don't need another answer but I agree that the pain pump is included in the primary procedure and should not be billed for separately. Any pain management by the surgeon is included in the global period per Medicare. Some other payers may cover it but you would have to use the unlisted code and, as was noted above, this may be more hassle than its worth. I never bill for them myself.

Lisi, CPC
 
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