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Orthopedic Coding Alert

Include Pain Pump Insertion in Knee, Shoulder Surgeries

You can usually collect for spinal pain pump insertions, but most other pain pumps bundle into main procedure Whether you're billing 37202, 11981 or an unlisted-procedure code, you're billing improperly for pain pump insertion following non-spinal orthopedic surgeries. That's because the American Academy of Orthopaedic Surgeons considers the pain pump insertion a component of the major procedure that the surgeon performs. Therefore, you should not report the insertion separately.

The procedure: Orthopedic surgeons will implant a catheter directly into a patient's surgical site to deliver postoperative pain medication, says Bill Mallon, MD, medical director at Triangle Orthopaedic Associates in Durham, N.C., and a pioneer in creating the implantable postsurgical pain pump.

"We started using them on shoulder surgeries, but the knee surgeons then began extending their use to ACL procedures," Mallon says. The surgeons usually remove the pain pumps after 48-72 hours.
Code the Pump as You'd Code a Drain: Not at All Wrong way: Coders tell us that they report either a site-specific unlisted-procedure code (such as 23929, Unlisted procedure, shoulder), 11981 (Insertion, non-biodegradable drug delivery implant) or even the cardiovascular code 37202 (Transcatheter therapy, infusion other than for thrombolysis, any type [e.g., spasmolytic, vasoconstrictive]) for surgical pain pump insertion. But whether or not your practice collects for these codes, you should not bill them when the surgeon implants a postsurgical pain pump.

Right way: You should include the surgeon's work implanting the pump in the global fee for the main surgery. "We are never allowed to code drain placement at the end of a procedure," Mallon says. "Pain pump placement is simply placing a drain, but in this case, instead of draining anything, local anesthetics are injected. But the difficulty is the same as a drain."

Mallon estimates that the pain pump placement takes about 10 seconds. "I have never tried to code for it, and if I worked at an insurance company, I'd deny it every time," he says.

Even if Insurer Pays for Insertion, Don't Bill It Pitfall: Some coders report that insurers have reimbursed them for pain pump insertions when they bill an unlisted-procedure code. However, just because the insurer pays you for a procedure doesn't mean you're coding correctly. If the insurer reviews your records and determines that you have improperly billed for pain pump insertion, you will likely be in hot water.

Most insurers' computer programs screen claims for pain pump insertion and deny the service if the practice bills the insertion with a surgical procedure, and "rightly so," says Chris Felthauser, CPC, CPC-H, a PMCC-approved medical coding instructor with Orion Medical Services.

In black and white: CIGNA, a Part B Medicare carrier in Idaho, North Carolina and Tennessee, publishes a policy that states that surgical wound catheters for postoperative [...]

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