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Intrathecal Infusion Implanted Pump refills

Lori Posted Tue 25th of October, 2016 18:32:03 PM
When refilling a implanted infusion pump what are the best codes to use. We are slightly confused on the difference between the 62369, 62370, 95990 and 95991. When refilling the pump they do run an analysis and reprogramming with the refill which matches the 62369, 62370. The 95990 and 95991 states refill with maintenance including analysis when performed.
SuperCoder Answered Wed 26th of October, 2016 09:47:03 AM

Our expert team is looking into this query. We will get back with the solution soon. Thank you 

SuperCoder Answered Wed 26th of October, 2016 09:48:13 AM

Our expert team is looking into this query. We will get back with the solution soon. Thank you 

SuperCoder Answered Thu 27th of October, 2016 03:53:38 AM

Hi,

As per the documentation, Use CPT 95991 if refill of the  pump is performed by the physician. Use CPT 95990 if refill of the  pump performed by the nurse.

Lori Posted Thu 27th of October, 2016 13:58:51 PM
But what is the difference in the codes? They both say refill but the 62369 and 62370 says analysis, reprogramming and refill. The 95990 and 95991 just say refill and maintenance. We always do an analysis when we do a pump refill and 50% of the time the patient wants a change so we do end up reprogramming a new dosage
SuperCoder Answered Fri 28th of October, 2016 06:19:40 AM

62367 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill62368 with reprogramming 
(For refilling and maintenance of an implantable infusion pump for spinal or brain drug therapy, see 95990 - 95991)


62369 with reprogramming and refill 


62370 with reprogramming and refill (requiring physician's skill) 
(Do not report 62367 - 62370 in conjunction with 95990, 95991. For refilling and maintenance of a reservoir or an implantable infusion pump for spinal or brain drug delivery without reprogramming, see 95990, 95991)


Rationale
The AMA/Specialty Society RVS Update Committee (RUC) identified codes 62367, 62368, 95990, and 95991 in the "Codes Reported Together 75% or More" screen. As a result, the services described by these codes have been combined as appropriate by revising code 62367, adding two new codes to this code family, and revising codes 95990 and 95991.

Codes 62369 and 62370 added to this code family to report electronic analysis of a programmable, implanted pump for intrathecal or epidural drug infusion, including reprogramming and refilling of the pump. Code 62369 is reported when a physician's skill is not required to perform the service. Code 62370 should be reported when the service does require a physician's skill.

Codes 62367 - 62370 should not be reported with codes 95990 and 95991. Codes 95990 and 95991 should be reported for refilling and maintenance without reprogramming (when performed) on a reservoir or an implantable infusion pump for spinal or brain drug delivery.


Clinical Example (62367)
A 65-year-old male presents for an electronic analysis of an implanted infusion pump that delivers opiates and has successfully controlled his pain due to prostate cancer and metastases to multiple bone sites in the lower body and resultant bilateral leg and pelvic bone pain (rated 8/10). Because of the multiple sites of bone involvement and lack of response to chemotherapy, no radiation therapy or further chemotherapy is planned. His expected survival time from his cancer is 9 months. The electronic analysis of the implanted pump device, which determines the rate of infusion and the amount of morphine solution remaining in the pump reservoir, indicates a satisfactory infusion rate and residual volume; so no reprogramming or refill is needed.
Description of Procedure (62367)
Electronic analysis is performed to determine reservoir status, alarm status, and the drug prescription status. Because the electronic analysis of the implanted pump device indicates a satisfactory infusion rate and residual volume; no reprogramming or refill is needed.


Clinical Example (62369)
A 65-year-old male has prostate cancer and metastases to multiple bone sites in the lowerbody and resultant bilateral leg and pelvic bone pain. A permanent implantable subcutaneous programmable infusion pump and an intrathecal infusion catheter were implanted for a long-term intrathecal infusion of narcotic. Because of inadequate pain control, the patient now presents for refill and reprogramming of his pump, not requiring physician's skill.
Description of Procedure (62369)
The nurse fills the pump under physician supervision and then electronic analysis is performed to determine reservoir status, alarm status, and the drug prescription status. Electronic analysis of the pump function verifies the infusion rate. Based on the patient's evaluation, the pump is then reprogrammed to adjust the rate of infusion and control the increased level of pain. The pump alarm settings and reservoir levels are programmed as well as any changes made to the drug infusion concentration or mixture. Refill date estimates are also made.

Refilling and Maintenance of Implantable Delivery Systems 

The services for refilling and maintaining implantable delivery systems (infusion pumps or reservoirs) that include intrathecal, intraventricular, and epidural drug delivery are described by codes 95990, Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal(intrathecal, epidural) or brain (intraventricular), and code 95991, Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician. The refill and maintenance of these types of pumps differs from that of systemic infusion in terms of risks, knowledge required, skill required, and severity of potential complications. Hence, codes 95990 and 95991 allow a more specific description, which reflects the work, time, and intensity for the refill and maintenance of pumps providing spinal or brain infusion as opposed to intravenous systemic infusion. Code 95990 has no physician work value and describes the services reported by the nonphysician provider, while code 95991 is reported for the physician services provided in the refilling and maintenance of the implantable pump or reservoir. 

The electronic analysis and/or reprogramming of programmable implantable infusion pumps is reported separately by the use of CPT codes 62367, Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming, or 62368, Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming, when performed at the same session as the refill and maintenance of the implantable pump or reservoir. A parenthetical note following code 95990 instructs users to refer to these codes for analysis and/or reprogramming. A point of significant consideration with respect to programmable pumps is that they require reprogramming at the time of refill. 


Clinical Scenario 1
A patient with a history of a failed back syndrome presents to the pain clinic for a routine pump refill. She meets with the practice's registered nurse (RN), reports no new symptoms, and states that she has continued good pain control. The RN performs the refill of the spinal opioid delivery system. The physician sees the patient and reprograms the pump without changing the daily dosage. The patient is informed of her refill date and sent home. 

CPT code 95990 is reported for the refill and maintenance of the implantable pump provided by the practice's RN. Code 62368 is reported for the reprogramming.




Clinical Scenario 2 
A patient with a history of osteoporosis and multiple compression fractures presents to the clinic for a refill of her implanted spinal opioid delivery system. She meets with the physician, complains of slight worsening of pain since her last visit, and requests that the dosage be increased. The physician performs the refill and reprograms the pump with a 10% increase in daily dosage. The physician does not prescribe any medication and does not manage any other medical issues. 

CPT code 95991 is reported for the pump refill provided by the physician. Code 62368 is reported for the reprogramming.
 

Lori Posted Fri 28th of October, 2016 12:05:38 PM
In your own answer you state "Do not report 62367-62370 in conjunction with 95990, 95991". Yet in your clinical Scenario 2 you state to code 95991 and 62368. Why not use the 62370 Electronic analysis of programmable implanted pump for intrathecal or epidural drug infusion with reprogramming and refill requiring physician's skill?
SuperCoder Answered Tue 01st of November, 2016 07:07:23 AM

Hi,

The difference between 62369-62370 and 95990-95991 is "Re-programming of the programmable pump".

Please find below explanation for the same:

As per coding guidelines, CPT 62367-62370 are not coded with 95990 and 95991.

CPT 95990 and 95991  used if patient is coming for refilling and maintenance of a reservoir or an implantable infusion pump for spinal or brain drug delivery without reprogramming.

CPT 62369-62370 are used if patient is coming for analysis and/or reprogramming of implantable infusion pump.

Codes 95990 and 95991 used to report refilling an implanted pump that is not programmable (i.e., constant flow or a reservoir). The programmable implanted infusion pump is re-programmed at each refill, so either 62369 or 62370 codes should be reported. Which of these two codes you report is based on who actually performs the services. For a physician or other qualified health care professional, you report 62370; for a clinical staff member, you bill 62369.

SuperCoder Answered Wed 02nd of November, 2016 02:37:50 AM

Hi,

The difference between 62369-62370 and 95990-95991 is "Re-programming of the programmable pump".

Please find below explanation for the same:

As per coding guidelines, CPT 62367-62370 are not coded with 95990 and 95991.

CPT 95990 and 95991  used if patient is coming for refilling and maintenance of a reservoir or an implantable infusion pump for spinal or brain drug delivery without reprogramming.

CPT 62369-62370 are used if patient is coming for analysis and/or reprogramming of implantable infusion pump.

Codes 95990 and 95991 used to report refilling an implanted pump that is not programmable (i.e., constant flow or a reservoir). The programmable implanted infusion pump is re-programmed at each refill, so either 62369 or 62370 codes should be reported. Which of these two codes you report is based on who actually performs the services. For a physician or other qualified health care professional, you report 62370; for a clinical staff member, you bill 62369.

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