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2019 coding for Intrathecal Pump Trial

Melissa Posted Tue 09th of April, 2019 10:10:46 AM
Is there a new code for a pump trial where the patient is monitored on site for 8 hours? I was using 62311 but it is being denied for LCD issues. Thank you
SuperCoder Answered Wed 10th of April, 2019 02:26:33 AM

Hi,

Thanks for your question.

Code 62311 is deleted from the CPT® code list from 01/01/2017 onwards. Code 62322 will be more appropriate to use as per the documentation provided.

Hope this helps.

Thanks.

Melissa Posted Mon 22nd of April, 2019 15:52:05 PM
thank you .....I actually did not mean to say we used 62311....we used 62323. because there does not appear to be another more appropriate code for an intrathecal pump trial when the injection is done in the lumbar area. Medicare has paid us for this in the past with no problem.. Now they are denying stating that it does not meet LCD Requirements, which it wouldn't because the LCD states that chronic low back pain is covered as long as it is caused by spinal degeneration, stenosis or radiculopathy in the lumbar area which this wasn't. Is there a better code to use?
SuperCoder Answered Tue 23rd of April, 2019 10:29:58 AM

Hi,

Thanks for your query.

We need more information from your end to provide you with appropriate answer to your query. Please provide the LCD ID and state information, so that we would be able to get the information about the denial. Also, please provide ICD-10 codes you used with this codes.

Thanks.

Melissa Posted Tue 23rd of April, 2019 11:05:40 AM
Kentucky LCD L34807-Lumbar Epidural Steroid Injections (ESI) We billed 62323 with G89.4 . The question is, Would 62323 be the most appropriate code to bill for an Intrathecal pump trial where the patient has the procedure and then is monitored on site for the next 8 hours? It does not meet the LCD requirement for ESI's, but all the information I can find says to use 62323 for a pump trial. Any assistance would be very much appreciated
SuperCoder Answered Wed 24th of April, 2019 10:07:18 AM

Hi,

Thanks for the information.

The LCD provide information for Lumbar Epidural steriod injections and it doesn't allow use of G89.4 with 62323. Please check the below list from the CMS website which includes list of ICD-10 that are supported with the code 62323.

>https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=56469&ver=2&LCDId=34807&Date=&DocID=L34807&bc=iAAAABABAAAA&

On the other hand, the intrathecal pump trial is done. Therefore, please check your documentation with code ranges 62360-62365. 

Hope this helps.

Thanks.

Melissa Posted Wed 24th of April, 2019 10:25:25 AM
Thank you. I reviewed the code range 62360-62365. Those codes appear to be for the actual implantation or reprogramming of the device. The pump trial is an injection into the spinal interspace; the patient is monitored on site for several hours and if the trial is successful, they would then schedule to proceed with an actual pump implantation. We have billed with 62323 in the past with no issues until now. Can you advise?
SuperCoder Answered Thu 25th of April, 2019 10:35:57 AM

Thanks for your query.

The appropriate code interlaminar epidural injection is 62323. The LCD states that the ICD-10 code G89.4 chronic pain syndrome is not allowed with the CPT code 62323. Please check the list of primary diagnosis provided below that can be allowed with 62323.

>https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=56469&ver=2&LCDId=34807&Date=&DocID=L34807&bc=iAAAABABAAAA&

Due to ICD-10 issue with CPT code 62323, they might be denying billing this service.

Hope this helps.

Thanks.

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