Pauline Posted Tue 11th of March, 2014 19:40:28 PM
IF A PATIENT HAS A INTRATHECAL PUMP IMPLANTED, AND WE NEED TO CHECK THE PUMP AND ENSURE THAT THE CATHETER IS FUNCTIONING PROPERLY BEFORE WE REPLACE THE PUMP DUE TO CURRENT END OF LIFE, HOW WOULD YOU CODE THIS PUMPOGRAM PROCEDURE THAT WAS PROVIDED?
A SIDE PORT ACCESS KIT WAS OPENED AND 24-GAUGE 1.5 INCH NEEDLE WAS INSERTED UNDER FLUOROSCOPIC GUIDANCE INTO THE SIDE PORT OF THE PUMP. wITH SOME DIFFICULT, 1.5CC OF CLEAR FLUID WAS EXTRACTED THROUGH THE NEEDLE. FOLLOWING THIS A TOTAL OF 6CC OF OMNIPAQUE 300 WAS INJECTED THROUGH THE CATHETER AND UNDER FLUOROSCOPIC IMAGING THERE WAS NOT EXTRAVASATION OF THE CONTRAST MATERIAL INTO THE PUMP POCKET OR ANYWHERE ELSE SURROUNDING THE CATHETER WHICH WAS FOLLOWED ALL THE WAY INTO THE INTRATHECAL SPACE WHERE A CHARACTERISTIC MYELOGRAM PATTERN WAS PRODUCED WITH THE CONTRAST FLIOWING MAINLY CAUDALLY AND INTO THE SACRAL POUCH. THE CATHETER APPEARED TO BE INTACT AND FUNCTIONING PROPERLY. OLLOWING THIS INJECTION CLEAR FREE FLOWING FLUID WAS EXTRACTED THROUGHT THE CATHETER MUCH MORE EASILY. THE PUMP WAS REPROGRAMMED TO DELIVER A PRIMING BOLUS OVER 12 MINUTES AND THEN BACK TO THE REGULAR SETTINGS OF MORPHINE 7MG PER DAY.
SuperCoder Answered Wed 12th of March, 2014 14:10:43 PM
Per July 2008 CPT Assistant:
Question: What is the appropriate code to use for reporting implanted pump catheter dye studies? The patient is not getting pain relief, and an intrathecal catheter is evaluated for dislodgement, discontinuity, or kinking. Contrast is injected through the catheter with fluoroscopic guidance to identify a potential problem.
Answer: It is appropriate to report code 75809, Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation, for the radiologic supervision and interpretation (RSI) portion of such a procedure to evaluate for shunt catheter patency or leakage. This code can be used for evaluation of a variety of similar and related nonvascular shunt catheters and devices, and requires the injection of contrast. Occasionally, evaluation for discontinuity is performed using plain radiography or CT imaging, without catheter contrast injection. In such cases, the service should be reported using appropriate radiography or CT codes describing which anatomical areas were imaged (eg, brain, neck, chest, and/or abdomen).
Implanted pump catheter dye studies typically require an injection component and an RSI component; therefore, it would also be appropriate for the physician performing the injection to report code 61070, Puncture of shunt tubing or reservoir for aspiration or injection procedure, to describe the injection service itself.
Pauline Posted Wed 12th of March, 2014 16:31:15 PM
Thank you for your time. This is what I thought, but wanted to double check.
SuperCoder Answered Wed 12th of March, 2014 22:01:55 PM