Patient Controlled Analgesia (PCA)

When patient controlled analgesia (PCA) is initiated in the recovery room by an anesthesiologist as part of his anesthesia time (see Medical Policy Bulletin A-8), the initial set-up time for PCA may be incorporated into the total number of anesthesia time units reported.

Any PCA services performed after the anesthesia care has ended, including initial set-up, subsequent adjustments, or follow-up related to this therapy are considered routine postoperative pain management, regardless of who performs it. When performed by the doctor who administered anesthesia, or by a member of his group/association, the postoperative pain management is part of the global anesthesia allowance. As such, if billed separately, the pain management is not covered. A participating, preferred, or network provider cannot bill the member for the denied service. However, when postoperative pain management is provided by a doctor other than those specified above, it should be denied as not covered. A participating, preferred, or network provider can bill the member for the denied service.

PCA administered for nonsurgical pain management is considered an integral part of a doctor's medical care. It is not eligible as a separate and distinct service when performed with medical care. If nonsurgical PCA is reported on the same day as medical care, and the charges are itemized, combine the charges and pay only the medical care. Payment for the medical care performed on the same date of service includes the allowance for the nonsurgical PCA. A participating, preferred, or network provider cannot bill the member separately for the nonsurgical PCA in this case.

If the nonsurgical PCA is performed independently, process it under code 99499.

Modifier 25 may be reported with medical care to identify it as a significant, separately identifiable service from the nonsurgical PCA. When the 25 modifier is reported, the patient’s records must clearly document that separately identifiable medical care has been rendered.

Epidural Analgesia

The pre-, intra, or post-operative insertion of an epidural catheter for post-operative pain control (codes 62318 and 62319, as appropriate) is not considered part of the global anesthesia allowance, and therefore, is eligible for separate payment. Daily Management of epidural drug administration (code 01996) is also eligible for separate payment after the day on which the catheter is inserted. Daily Management reported on the same day as the catheter insertion is not covered. A participating, preferred, or network provider cannot bill the member for Daily Management on the same day as the catheter insertion.

Payment can also be made for the insertion of an epidural catheter (codes 62318 and 62319, as appropriate) for the treatment of a nonsurgical condition. Daily Management of epidural drug administration (code 01996) is also eligible for separate payment after the day on which the catheter is inserted. Daily Management reported on the same day as the catheter insertion is not covered. A participating, preferred, or network provider cannot bill the member for Daily Management on the same day as the catheter insertion.

In addition, an epidural injection administered as a therapeutic agent in the treatment of a nonsurgical condition (e.g., chronic low back pain, cancer, etc.) should be reported under code 62311 or 62319, as appropriate. Any follow-up care should be reimbursed based on the level of medical care reported (e.g., intermediate, extended, etc.).

NOTE:

Refer to Medical Policy Bulletin A-5 for epidural anesthesia for relief of pain during labor and delivery.

Nerve Blocks

An injection/block administered pre-, intra-, or postoperatively is not considered part of the global anesthesia allowance and, therefore, is eligible for separate payment. These injection/block procedures should be reported under codes 62273-62282, 62310-62319, 64400-64450, 64505-64530, as appropriate.

Injections/blocks administered as a therapeutic agent in the treatment of a nonsurgical condition should be reported under codes 62273-62282, 62310-62319, 64400-64450, 64505-64530.

Refer to Medical Policy Bulletin S-100 when multiple nerve blocks are given during the same session.

Refer to Medical Policy Bulletin A-8 when a nerve block is administered as an anesthesia service.

Refer to Medical Policy Bulletin S-40 for drug infusion via an implantable pump.

Refer to Medical Policy Bulletin A-2 for additional information on nerve blocks and modifier 59. The A-2 policy guidelines are also applicable to nerve blocks when provided as anesthesia for surgery by the operating surgeon.

Refer to Medical Policy Bulletin S-189 for information on transforaminal epidural injections.

Refer to Medical Policy Bulletin Z-61 for information on paravertebral facet joint nerve blocks.

Description

Various methods of pain management may be used for both post-operative and nonsurgical pain control. Below are the most common techniques:

Patient Controlled Analgesia

Patient controlled analgesia therapy is a technique for pain management that involves self-administration of intravenous drugs through an infusion device.

Epidural Analgesia

Epidural analgesia involves the administration of a narcotic drug through an epidural catheter.

Nerve Blocks

A nerve block involves the injection of an anesthetic agent into or around a given nerve.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.