My group thinks they may be able to collect some more units by performing a separate postoperative evaluation of patients that have received Duramorph for postoperative pain control (typically only our C-section pts since our orthopods hate Duramorph). One of my other colleagues thinks that if he does a combined spinal/epidural with Fentanyl he can also perform a postoperative visit since he states "any opiate in the neuraxis" is included...which seems like a stretch. It makes sense with indwelling catheters but has anyone had luck with Duramorph or Fentanyl in the neuraxis (spinal or epidural)? I tried looking at the CMS guidelines but am just curious if anyone has been successful with their billing company or has any literature sources.
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Arch Guillotti
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Duramorph, not fentanyl. Sorry, no sources.
It's code 01996, same code for rounding on a post op epidural and intrathecal drug. I've billed it for intrathecal morphine, one post op visit, but never fentanyl. I agree, sounds like a stretch and it's not worth the trouble for 1 unit. In general though, CMS applies to those patients and all other insurance companies have Local Coverage Determinations which spell out exactly what they pay for, so you'd have to search all of the products your patients have. Billing 01996 for intrathecal fentanyl would probably catch the eye of a coder somewhere and start getting denials, they're pretty good at those.
