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Thread: Pca

  1. #11
    Join Date
    Apr 2007
    Pasadena, CA

    Question Still confused about PCA

    AAPC: Back to School
    Hi Kamala, I'm an Anesthesia Coder and we have two offices that bill differently for PCA, I don't understand when the Dr. marks "PCA" or "F/U visit for pain management" we usually bill code: 99231=2 units for the 1st and all subsequent days of Dr F/U, we usually get progress notes with the anesthesiologist notes for the pain check up on the patient, but NOTE that there's not always a catheter so we cannot bill for 01996 (unless 62318-62319). what do you think we can bill for the "PCA" or "F/U visit for Pain Mgmt" which are documented in progress notes when there's no 62318-62319 placed?


  2. #12

    Default PCA Billing

    PCA is for Patient Controlled Analgesia. Medicare does not pay for this service so don't bother trying to bill it to them. Other carriers vary on their acceptance of this type of pain management. I have seen physicians use it for both pain control, and post operative pain relief. It can be billed separately from the main procedure. You need to check with your carriers to see which codes they prefer. We bill in Alabama, BCBS of AL and Workers Comp want 01999, Medicaid and commercial carriers want 90765/90766 and United Healthcare wants 62319.

    If your carrier does not have any specific guidelines regarding PCA's try 90765 and 90766 for the initial day and 90766 for follow-up days. It is always a good idea to have documentation on file including the order for the PCA as well as the notes regarding placement, management and D/C date.

    If you are coding for postoperative pain be sure to code v58.49 for post-surgical states as your secondary code.

    Hope this helps.
    Last edited by hgolfos; 10-03-2008 at 01:06 PM. Reason: Add more info

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