General
Chapter 1
Section 10
Postoperative Pain Management
- Epidural Analgesia
Issue Date: February 21, 1995
Copyright: CPT
only © 2006 American Medical Association (or such other date of
publication of CPT).
All Rights Reserved.
Revision:
1.0 APPLICABILITY
This policy is mandatory for reimbursement
of services provided by either network or non-network providers.
However, alternative network reimbursement methodologies are permitted
when approved by the Defense Health Agency (DHA) and specifically
included in the network provider agreement.
2.0 ISSUE
How are physicians to be reimbursed for postoperative
pain management?
3.0 BACKGROUND
3.1 Postoperative
pain management consisting mainly of the intramuscular (IM) and/or intravenous
(IV) administration of patient controlled analgesia (PCA) is considered
a part of the global charge for the surgery. The administration
of epidural analgesia is a specialized technique that can only be
provided by a specially trained physician. It includes the following
services:
• Placement
of the epidural catheter (an invasive procedure requiring about
20 minutes).
• Mixing
of the epidural analgesia infusion.
• Programming and
initiation of infusion pump.
• Completion of detailed
epidural analgesia orders.
• Daily monitoring
and adjustment of epidural and infusion pump.
• Twenty-four hour
availability/coverage to physically respond to problems/complications.
3.2 Since postoperative
epidural analgesia care represents a level of services above that
of routine postoperative pain relief provided by physicians, it
is allowed outside the global surgical fee subject to the following
reimbursement guidelines.
4.0 POLICY
4.1 Payment
of postoperative pain management outside the global surgical fee
is only allowed for epidural analgesia care provided and billed
by a physician. TRICARE will pay the physician for:
4.1.1 Insertion of the epidural
catheter (CPT procedure codes 62278 and 62279 - epidural, lumbar
or caudal, continuous) on the day of the surgery; and
4.1.2 Daily hospital
management of epidural drug administration (CPT procedure code 01996) following
the day of surgery (not the day of surgery).
4.2 The physician
is only allowed to bill one pain management procedure code (CPT
procedure code 01996) per day. The procedure includes all visits
and contacts during the 24-hour time period to adjust the dosage
and to maintain a functioning catheter.
4.3 Daily hospital management
of epidural drug administration will be paid up to 3 days following the
day of surgery. Additional management services may be allowed at
the discretion of the contractor based on best commercial practices.
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