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Intrathecal Pump Trial

Melissa Posted Wed 23rd of April, 2014 11:16:20 AM

Our pain management physician is performing single injection intrathecal pump trials and the patient is being observed in the office afterwards. I am coding 62311 since the pump is not being placed. I am being told I should code 62319, but everything I am reading says 62311

SuperCoder Answered Wed 23rd of April, 2014 17:59:21 PM

A single-shot trial period could be one day, a continuous infusion trial two or three days, and a trial with the catheter tunneled with an external pump three days to two weeks.

1. Single injection of medication (or single-shot) trial: You can do a trial by just performing a single-shot intraspinal morphine injection and observing the patient for 24 hours. However, a 24-hour trial period might not truly reflect the patient's pain situation. If the anesthesiologist decides on this trial method, depending on the location of the injection, code the procedure with CPT 62310 (injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or CPT 62311 (... lumbar, sacral [caudal].

2. Continuous infusion: "The next best thing to a single injection is to place a temporary intraspinal catheter over three to five days and slowly infuse morphine, reproducing what the actual pump would do. Some physicians choose longer trial periods, allowing the patient to return home with the trial pump in order to acquire a truer picture of its effectiveness. People might tolerate the pump for a few days as inpatients, but find that the pump doesn't manage the pain as effectively once they resume the daily activities of home. That's why physicians believe that the "ideal" pump trial lasts two weeks. The trial is usually a continuous ambulatory delivery (CADD) pump the patient wears at home during normal activities to determine more accurately whether an implantable pump will bring significant relief.

You can use the following codes for continuous infusion trial catheters that are in place for more than one day:

62318 (injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or ubarachnoid; cervical or thoracic) or

62319 (... lumbar, sacral [caudal]).

3. Tunneled catheter with external pump: Physicians use this procedure when they anticipate a successful trial in which the catheter remains in place for an indefinite time. If this is the choice, use 62350 (implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy).

Note: If a patient is visited for daily management of a pump or catheter, use code 01996 (daily management of epidural or subarachnoid drug administration) for any days after the original procedure, codes 62319, 62318 or 62350.

If a trial fails (because, for example, the pain is not opiate sensitive), the physician removes the catheter, a surgical procedure that might take several hours because the catheter is buried and anchored, Rivera says. If the anesthesiologist, rather than a surgeon, removes the catheter, use 62355 (removal of previously implanted intrathecal or epidural catheter). However, if the anesthesiologist only provides anesthesia during the procedure and does not remove the catheter, report 00300 (anesthesia for procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified).

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