Results 1 to 2 of 2

Help! Pain pump

  1. #1
    Default Help! Pain pump
    Medical Coding Books
    Are any of you in the ASC setting billing for a pain pump? I'm having a hard time finding the correct code to bill. Here is an example of an op note that I sent to a separate coding company to help me. They coded with a 49999 for the abdominal exploration and A4300 for the On'Q pain catheter. My questions are, would there not also need to be a code for the resection of the nerve branches? And is the A4300 the correct code for the On-Q and pump?

    DESCRIPTION OF PROCEDURE: Mr. X has had several blocks, currently improved his pain in his left upper abdominal wall. He was able to localize his pain to a region approximately size of a quarter. We discussed specifically in great detail of the risk and benefit of the surgery and he was well aware of these risks due to his previous operations, but those risks include and were not limited to bleeding, infection, damage to nerves and vessels, need for further surgery, incomplete resolution of symptoms, and worsening of symptoms. He signed the consent form. He was taken to the operating room and placed in a supine position. We had marked the location of his pain preoperatively and this correlated with his preoperative blocks, all of which were at least modestly successful with at least a four-point drop in his pain, if not five. The surgical site was then marked and I used a 15-blade scalpel and a transverse incision to connect the two previous incisions that he had one medial and one lateral. I carefully divided the subcutaneous tissue down to abdominal wall fascia. Careful retraction was used and I searched the external oblique fascia for any evidence of the T8 or T9 intercostal nerve root, lateral branch that reached out and was likely in this portion of his abdominal wall. I searched the region measuring approximately 10-cm x 20-cm in width. This was well outside the borders of the quarter sized area where he reported his pain to be. I did not identify any substantial peripheral nerves, but I did identify one small structure of more than a tiny nerve branch. This was cauterized and resected. I sent the specimens to pathologist. I then continued my search in the same plane, but still could not find any. I then carefully searched the similar subcutaneous tissue. I felt that if this was consistent with diagnoses that we had previously documented, but the location of this branch should have been identified this time. I do not identify any branches in the subcutaneous tissue. The patient was morbidly obese and the subcutaneous tissue was quite thick. The decision was made to stop searching and to implant an “On-Q” pain catheter. We therefore filled up 400 cc of 0.25% Marcaine from the On-Q pump balloon up. I then secured this to a 5-mm per hour catheter. It was placed through a separate large irrigation needle into the subcutaneous pocket on the level of the abdominal fascia. I then flushed the catheter.

    I irrigated the abdominal wall with saline and then closed in layers with 3-0 Monocryl deep and Scarpa's layers and then 4-0 Monocryl deep dermal and 4-0 Monocryl subcuticular and Dermabond. A sterile dressing was applied. The catheter itself was also put in place and placed under several Tegaderm. The patient was awoken from anesthesia and transferred to the recovery room in stable condition.

    Thanks for any help!

    Kristie Stokes, CPC, CPMA, CCS, CMDP, ICDCT-CM

    AAPCCA Board of Directors 2014-2017
    Region 1 - Northeast
    Maine, New Hampshire, Vermont, Massachusetts, Connecticut, Rhode Island, New York

    Today, give a stranger one of your smiles. It might be the only sunshine they see all day.

  2. #2
    Philadelphia, PA
    Hi we use A4305, and have no problem getting paid, of course you need a contract to stipulate the carve out...

Similar Threads

  1. ON-Q Pain pump
    By AWHITACRE in forum Outpatient Facilities
    Replies: 0
    Last Post: 02-20-2014, 11:46 AM
  2. On Q Pain Pump
    By Leandra in forum OB/GYN
    Replies: 2
    Last Post: 10-11-2011, 02:48 PM
  3. Pain Pump
    By kmcafee in forum General Surgery
    Replies: 4
    Last Post: 08-23-2011, 08:09 PM
  4. ON-Q Pain Pump
    By valariej in forum General Surgery
    Replies: 6
    Last Post: 10-21-2009, 09:51 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.