The Neurosurgery Coding Coach
KZA consultants discuss two frequently asked neurosurgery coding questions every month. Our coding experts are also available for hourly coding consultations and can provide a customized coding and documentation review for your practice.
March 4, 2010
Implantable Pain Management System
Question:
The vendor representative told us to use 11981 (Insertion, non-biodegradable drug delivery implant) with a 59 modifier when we place a catheter for postoperative pain management at the time of a spine procedure. We have some insurance carriers that pay this but many don’t. Do you have any suggestions on how I can get this paid?
Answer:
No, I don’t. And, I don’t think you are going to like my answer. Refer to the May 1999 CPT Assistant on page 8. In summary it says pain management services may be billed by someone other than the physician performing the surgical services. Furthermore, the physician specialty societies (e.g., AAOS, AANS, ACS) say the placement of pain management devices for control of postoperative pain is included in the global surgical package for the primary surgeon and not separately billable.
Remember, just because you got paid on an incorrectly coded claim doesn't make it right. Placement of this or any other activity to facilitate postop pain management is not separately billable for the surgeon. Payor rules may allow reimbursement just as you've noted. But again the coding rules override the fact that the code you billed made it through the payor's edits.
If you have questions or would like to speak to Kim or Teri about how this affects your practice, please contact Robin Delgatto at KZA (rdelgatto@karenzupko.com or 312.642.5616), and he will be happy to share with you KZA’s fees for this service.
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