For Physicians For Facilities Hospital Inpatient / DRG When using the ambIT® PCA or PreSet™ Pain Control System in the inpatient setting, it is covered under the negotiated payment to the hospital. In most cases this is covered under the DRG or Per Diem Rate. If there is an instance where the cost of care is reimbursed under a billed charges scenario, the ambIT® Pump will be billed as a line item supply using revenue code 272 or HCPCS code E0781. Hospital Inpatient Reimbursement DRG Description Relative Weight 233 Other Musculoskeletal System and Connective Tissue OR Procedures w/ CC 1.9028 234 Other Musculoskeletal System and Connective Tissue OR Procedures w/out CC 1.2580 223 Major Shoulder/Elbow Procedures or Other Upper Extremity Procedures w/ CC 1.1727 224 Shoulder, Elbow or Forearm Procedures Except Major Joint Procedures w/out CC 0.8582 236 Fractures of Hip and Pelvis 1.6305 Outpatient Prospective Payment System Outpatient hospitals use the Outpatient Prospective Payment System (APC) to bill for procedures. These codes are reimbursed similar to a DRG. Each type of procedure is assigned an APC for coding and reimbursement. All procedures that fall under this code are paid at a fixed amount and the payment is considered inclusive of supplies, etc. Non Medicare Outpatient and Ambulatory Surgery Center Claims Outpatient Hospitals and Ambulatory Surgery Centers bill their charges using the same CPT Codes used by the physician. These codes are then reimbursed either at a percent of charges, contract rates or globally. Payment will vary widely depending on the payer and facility contracts. ASC Grouper Codes Ambulatory Surgery Centers (ASC) bill Medicare and other Government Payers claims using ASC Grouper codes; currently there are nine categories. At this time the continuous infusion codes are excluded from the ASC Grouper list. Hospital Outpatient and ASC Coding CPT Code Description APC Single Shot 64115 Single Shot Brachial Plexus 204 64445 Single Shot Sciatic 204 64447 Single Shot Femoral 204 The use of modifiers 51, 59, and 79 may be used when appropriate. Continuous 64416 Nerve Block, Continuous Infuse Brachial Plexus 204 64448 Nerve Block Injection Femoral Continuous Infusion 204 64446 Nerve Block Injection Sciatic Continuous Infusion 206 64450 Nerve Block Injection, Other Peripheral Nerve Branch, Continuous Infusion 204 64449 Lumbar Plexus, Posterior Approach, Continuous Infusion by Catheter 204 Facility Reimbursement CPT Description APC ASC Grouper 62350 Implantation, revision or repositioning of tunneled intrathecal catheter for long term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy 223 2 62318 Bolus-Injection of medication via spinal catheter, epidural or subarachnoid, cervical or thoracic 207 1 62319 Bolus-Injection of medication via spinal catheter, lumbar or thoracic 207 1 77003 Fluoroscopy for catheter placement n/a n/a 62355 Removal of implanted catheter (intrathecal or epidural) 203 2 Product Reimbursement The ambIT® PCA or PreSet™ Pain Control System can be billed for using HCPCS code E0781. Charges to the payer should be invoice cost plus an additional facility mark up fee. Usual mark up fee is about 15%. The supplies for the ambIT® PCA or PreSet™ pump should be billed using the following HCPCS codes: *A4221 Supplies for maintenance of drug infusion catheter, per week (list drug separately) *A4222 Supplies for external drug infusion pump, per cassette or bag (list drug separately). If facility does not have a DME License, the Misc. Code 99070 may be used. If you have any questions, please contact Sorenson Medical at service@sorensonmedical.com. This information is provided as a guide for coding pain management procedures. It is not intended to increase or maximize reimbursement by any payer. This information is intended to assist providers and facilities in accurately obtaining coverage and reimbursement for health care services. It is always the providerÕs responsibility to determine the appropriate codes and modifiers to be submitted. We strongly advise the provider consult with their payer organizations to obtain current local coverage and reimbursement policies.