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Cpt 62311

  1. #1
    Default Cpt 62311
    Medical Coding Books
    My doc performed an intrathecal trial for a patient with chronic abdominal, arm and leg pain. He billed 62311 and the insurance company is asking for a specific dx code (more having to do with the back, nerves, etc.) What advice or suggestion should be given for this to be paid?

  2. #2

    According the Local Coverage determination that I reviewd for 62311, 338.29 other chronic pain is on conditions that meet medical necesscity. Below is the NCD that I thought I would share
    __________________________________________________ ____________________

    Opioid Drugs for Treatment of Chronic Intractable Pain

    An implantable infusion pump is covered when used to administer opioid drugs (e.g., morphine) intrathecally or epidurally for treatment of severe chronic intractable pain of malignant or nonmalignant origin in patients who have a life expectancy of at least 3 months, and who have proven unresponsive to less invasive medical therapy as determined by the following criteria:

    The patient's history must indicate that he/she would not respond adequately to noninvasive methods of pain control, such as systemic opioids (including attempts to eliminate physical and behavioral abnormalities which may cause an exaggerated reaction to pain); and a preliminary trial of intraspinal opioid drug administration must be undertaken with a temporary intrathecal/epidural catheter to substantiate adequately acceptable pain relief and degree of side effects (including effects on the activities of daily living) and patient acceptance.

  3. Default 62311
    I work for a pain management doctor and he does a lot of the procedure 62311 and he has a diagnosis of 7225.52 & 724.4, and we get paid from all insurance companies.

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