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DESCRIPTIONPostoperative pain management is achieved by applying effective methods of analgesic control. Many factors influence the incidence and severity of postoperative pain. Infants and elderly patients seem to experience less pain than middle-aged patients. The need for postoperative pain medication is reduced when the anesthesiologist visits patients preoperatively and provides detailed explanations of postoperative events, including the occurrence of pain. The site of operation influences the severity of postoperative pain, with thoracotomy and upper abdominal and orthopaedic surgery being the most painful. Patients should be seen daily to evaluate the quality of analgesia, side effects, appropriate dosage, and inspection of IV and epidural sites. Several methods of analgesic control are listed below:
The patient is placed in the sitting or lateral decubitus position for the physician to insert a catheter into the vertebral interspace of the cervical or thoracic region for continuous or intermittent infusion of material. The site to be entered is sterilized, local anesthesia is administered and the infusion catheter is inserted. Contrast media with fluoroscopy may be injected to confirm proper placement. The physician provides continuous infusion or intermittent bolus injections of an anesthetic solution. The solution is injected into the epidural or subarachnoid space. With the procedure complete the needle is removed and the wound dressed.
Implantable Infusion Pump
Refer to the Implantable Infusion Pump medical policy.
Intravenous Patient-Controlled Analgesia (IV-PCA)
The patient pushes a button and self-administers low doses of intravenous narcotic medication via a pump for the relief of pain. This type of pain control is managed by the operating surgeon or an anesthesiologist. It can be used for postoperative pain, in hospitalized patients with other types of severe pain and in the management of chronic pain due to cancer. The device is programmed to limit the hourly dosage and intervals between doses to prevent overdosing. IV-PCA should not be confused with pain control infusion pumps.
Pain Control Infusion Pump
Refer to the Pain Control Infusion Pump medical policy.
Single Injection of Narcotics
The patient is placed in a sitting or lateral decubitus position for the physician to insert a needle into the vertebral interspace of the lumbar or sacral region. The site to be entered is sterilized, local anesthesia administered and the needle is inserted. Contrast media may be injected to confirm proper needle placement under fluoroscopy. The physician injects an anesthetic solution into the epidural or subarachnoid space. With the procedure complete, the needle is removed and the wound is dressed.
The management of postoperative pain following surgical procedures is included in the attending physician's evaluation and management services. Charges for these services should not be billed separately.
If the management of postoperative pain is provided by an anesthesiologist, the following guidelines apply:
B. Intravenous patient-controlled analgesia (IV-PCA) is included in the global fee for administration of general anesthesia and should not be billed separately.
C. A single injection of a narcotic immediately prior to or following the administration of general anesthesia is not included in the global fee for administration of the anesthesia. This injection can be billed separately.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY11/1999: Approved by Medical Policy Advisory Committee (MPAC)
1/11/01: Policy "Patient-Controlled Analgesia" renamed "Postoperative Pain Management"
2/2001: Interim Policy approved by MPAC; Existing coverage unchanged. Policy revised to include anesthesiologist management by continuous/intermittent epidural and a single injection of a narcotic following the administration of general anesthesia
5/2/2002: Type of Service and Place of Service deleted
11/12/2003: Code Reference section updated, CPT code 01997 deleted
2/16/06: Section C of POLICY updated to allow for a separate allowance for a single injection of narcotic following the administration of general anesthesia (per BCBSMS Managment, effective 8/2004)
12/31/2008: Policy reviewed, no changes
12/31/2008: Code reference section updated per 2009 CPT/HCPCS revisions
06/03/2010: Policy description and statement unchanged. Coding section updated to move CPT code 62311 from non-covered to covered per the policy statement for the administration of a single injection.
06/11/2014: Policy statement regarding a single injection of a narcotic following the administration of general anesthesia was revised to state that the narcotic injection can be administered immediately prior to or following the administration of general anesthesia.
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 64486, 64487, 64488, and 64489.
08/14/2015: Code Reference section updated for ICD-10.
12/31/2015: Code Reference section updated to add CPT codes 64463 and 64999.
06/01/2016: Policy number added.
SOURCE(S)Basics of Anesthesia, 2nd ed. (Robert K. Stoelting, M.D. and Ronald Miller, M.D.), Churchill Livingstone, Inc., New York, Edinburgh, London, Melbourne, Tokyo (1989), pp . 435.
Blue Cross Blue Shield Association policy # 10.01.07
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
Not Medically Necessary Codes