Stryker Pain Pump

Kris Cuddy

Harrison, MI
Best answers
Pain pumps are not billable. Doesn't that seem ridiculous? Yet, it's true.

From an email August 6, 2007 at WPS Medicare enews:

We have had several inquiries concerning the proper billing for the insertion of pain pumps placed at the end of major thoracic and orthopedic cases. Some of the better known devices are the ON-Q Pain Buster, the Stryker Pain Pump System, and the DonJoy Pain Control Device. These provide pain management by a continuous infusion of a local anesthetic through a catheter directly into the patient's surgical site. The four main arguments for payment that we have heard are:

1) the pump insertion is not inclusive to the main procedure;

2) there is more work in putting in the pump;

3) the patient is more uncomfortable without it; and

4) the hospital stay may be lengthened without the device.

1. We agree that there is some additional work in inserting the pump. However, the real issues are whether the procedure is standard, whether it is truly a separate procedure, whether it is allowed by Medicare regulations, and whether it requires a significant amount of additional work. After reviewing many operative reports, manufacturers' websites, and the medical literature, any additional work appears to be very minimal.

2. Per the National Coverage Provisions (and also found on GSURG-001 on our Website), a global surgery package includes "Postsurgical Pain Management - By the surgeon." Thus, the insertion of such a pump is included in the overall surgeon's payment.

3. While the hospital stay may be shortened, this is not an issue.
We have seen these pumps being billed under several CPT and HCPCS codes including A4306, 11981, 23929, and 32999. Billing for these pumps under these or other CPT/HCPCS codes is not appropriate. They should not be billed separately.

Stephen D. Boren MD
Carrier Medical Director Illinois and Minnesota

Hope this helps,