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Thread: coding on-q pain pump insertion

  1. #1

    Question coding on-q pain pump insertion

    One of my physicians turned in a charge for insertion of an On-Q pump with a Laparoscopic Hernia Repair. Does anyone know if I can bill for this and if so, how?

  2. #2

    Default

    we use 11981 when we charge for pain pumps

  3. #3
    Join Date
    Apr 2007
    Posts
    16

    Default coding for pain pumps

    We have been told by the On-Q rep to use unlisted codes. For example, if we place an On-Q with an inguinal hernia repair we would bill 49999 for the pain pump. Most insurance companies will pend the claim for review. It took an average of 45 days to get the claim paid. Cigna has advised us that 11981 is more appropriate than an unlisted code. Needless to say we are billing 11981 to Cigna.

  4. #4
    Join Date
    Apr 2007
    Posts
    11

    Default on q pain pump insertion

    Here are the codes that are used for the pump inserts

    64416 – brachial plexus
    64446 – sciatic nerve
    64448 – femoral nerve
    64449 – lumbar plexus
    76942 – ultrasound guided (different revenue code) (no separate payment, it is included in codes above

  5. #5

    Default

    racosta, has Cigna paid the 11981? What other ins companies have you billed it to and have they paid it? I have had some ins companies pay the 49999 after sending in documentation and appealing it. Some BCBS and some of the no name private insurances. Thanks

  6. #6
    Join Date
    Apr 2007
    Location
    Martinez
    Posts
    9

    Question

    Quote Originally Posted by racosta View Post
    We have been told by the On-Q rep to use unlisted codes. For example, if we place an On-Q with an inguinal hernia repair we would bill 49999 for the pain pump. Most insurance companies will pend the claim for review. It took an average of 45 days to get the claim paid. Cigna has advised us that 11981 is more appropriate than an unlisted code. Needless to say we are billing 11981 to Cigna.
    As a payer, we have chosen to adopt CPT ciode 11981 for the On-Q pain pump. My question is this; How did Cigna communicate to you as a provider that they required this code when billing an On-Q? As a rule, we don't tell our providers how to bill, however, if there is a way to communicate this to our network of providers, I would be most grateful for any direction anyone can give. Thanks for your help!!!

  7. #7

    Default

    Quote Originally Posted by kknapp View Post
    Here are the codes that are used for the pump inserts

    64416 – brachial plexus
    64446 – sciatic nerve
    64448 – femoral nerve
    64449 – lumbar plexus
    76942 – ultrasound guided (different revenue code) (no separate payment, it is included in codes above
    Thanks for your reply. I have researched these codes. I don't think any of these would be what I am looking for. My physicians use this pump with abdominal surgeries and state it was placed in the "preperitoneal space". I didn't see any mentioned above that would fit that description.
    Thanks again for your help.

  8. #8

    Default

    I have read that 11981 doesn't "accurately the describe the service" - it has nothing to do with pain control. I wish I could find that article. That's interesting that Cigna uses it.....hmmmm.
    My plastics doc wanted to bill it and I believe I found the article in a plastics magazine that said do not use... even though it's a pain to bill the unlisted code, that's the way we've been doing it.....

  9. #9

    Default coding on a q pain pump removal

    I am looking for any documentation to determine when it would be appropriate to bill for q pain pump removal by a physician or PA.

    Specifically is this usually only billed when a patient is given some type of sedation or can it be appropriately billed at any time?

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