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Continuous/Intermittent Epidural

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.

If the management of postoperative pain is provided by an anesthesiologist, the following guidelines apply:
 
A.  For pain management by continuous/intermittent epidural:
      1.  Allow payment for 62318 once, on the first day of service. This code includes insertion of the catheter and injection of the anesthetic substance.
      2.  Allow payment for 01996 for daily management of the epidural drug administration after the day on which the catheter was introduced. Do not allow both 01996 and 62318 on the same day. Documentation supporting medical necessity must be submitted for treatment exceeding 3 days.

B.  Intravenous patient-controlled analgesia (IV-PCA) is included in the global fee for administration of general anesthesia and should not be billed separately.

• For hospitalized patients, most of the cost associated with intravenous patient-controlled analgesia (IV-PCA) is an itemized part of the facility reimbursement (e.g., drug, pump/meter, IV hook-up and associated nursing care).
• The IV-PCA professional (physician/anesthesiologist) services may not be billed separately. This would include the following services:
  1.  Initial consultation/visit
  2.  Subsequent consultations/visits
  3.  Dosing
  4.  Calibration/recalibration of the PCA pump
  5.  Any other services associated with the management of patient controlled analgesia

C.  A single injection of a narcotic following the administration of general anesthesia is not included in the global fee for administration of the anesthesia.  This injection can be billed separately.

NOTE: It is not appropriate for providers to bill the patient for services outlined in B.

None

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

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.

Blue Cross Blue Shield Association policy # 10.01.07

The code(s) listed below are ONLY covered if the procedure is performed according to the "Policy" section of this document.

Covered Codes

The code(s) listed below and ANY code not listed in the previous section are considered non-covered for this procedure. 

Non-Covered Codes

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