Hospitalization
Prior authorization is required for hospitalization for the implantable pump procedure. Catheter implantation, pump/reservoir implantation, removal of pump/reservoir, and electronic analysis of the programmable, implanted pump may be reimbursable with the following codes and appropriate modifiers.
CPT-4 Code Definition
Catheter Implantation
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
62351 with laminectomy
62355 Removal of previously implanted intrathecal or epidural catheter
Reservoir/Pump Implantation
62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming
Removal of Reservoir or Pump
62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion.
Electronic Analysis of Pump
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
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 Infusion pumps are used for the controlled administration of opioids in pain management. Pumps may be worn externally by the patient or may be implanted subcutaneously. Both types of infusion pump may be attached to an implantable epidural or intrathecal catheter for administration of analgesia. External pumps may be used in some patients, especially if the expected duration of use is short. External infusion pumps may be reimbursable when billed with the following HCPCS codes.
New CPT Codes:
The following new codes are reported for electronic analysis of programmable implanted pump for Intrathecal or epidural drug infusion.
62369 Electronic analysis of programmable, implanted pump for Intrathecal or epidural drug infusion (including evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill 62370 with reprogramming and refill (requiring physician’s skill)
The following bullets represent information you need to review regarding new CPT codes 62369 and 62370:
• Both codes were added to the coding family to describe electronic analysis with reprogramming and refill.
• Code 62369 is reported when physician skill is not required to reprogram and refill.
• Code 62370 is reported when reprogramming and refill require physician’s skill.
• Assign appropriate code if this is the only procedure being performed. Initial programming and fill are considered integral to codes 62360-62362.
• These codes are used on implanted pumps only.
• Do not report these codes in conjunction with 95990-95991.
• For refilling and maintenance of a spinal or brain drug delivery reservoir or implanted infusion pump without reprogramming and/or analysis, see codes 95990 and 95991 per the parenthetical note.
Example of 62369:
A nurse or other healthcare professional fills the implanted pump under physician supervision and then electronic analysis is performed to verify pump function and the patient’s reservoir status, alarm status and drug prescription status. This function verifies the patient drug infusion rate. Reprogramming of the pump functions is then performed along with any adjustments to the infusion rate, mixture or concentration.
Example of 62370:
The physician prepares the entire area over the implanted pump. Sterile technique is used throughout the procedure to prevent infection. The proper kit is used and the residual medication is aspirated from the reservoir and measured, recorded and the new solution injected by the physician. Pump function is verified along with reprogramming of the pump functions, and any adjustments to the infusion rate, mixture or concentration.
Supporting Analysis after the rejection or dispute
The dispute regards the denial of the refilling and maintenance (96530 Modifier 59) and electronic analysis (62368) of implantable pump services on date of service 3/12/2013. The Claims Administrator denied the billed procedure codes 96530 and 62368 indicating “Charge for a “separate procedure” that does not meet the criteria for payment. See the OMFS General Instructions for Separate Procedure rule.”
The Provider billed the following services for date of service 3/12/2013:
CPT 62362 – Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming.
CPT 62350 – Implantation, revision or repositioning of intrathecal or epidural catheter, for implantable reservoir or implantable infusion pump; without laminectomy.
CPT 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.
CPT 76003 – Fluoroscopic localization for needle biopsy or fine needle aspiration.
CPT 96530 – Refilling and maintenance of implantable pump or reservoir.
Modifier 59 – Distinct procedural service.
The Claims Administrator reimbursed the Provider for the billed codes: 62362 and 62350. The billed codes: 76003, 62368 and 96530 were denied by the Claims Administrator. The Provider is disputing the denial of the billed codes 62368 and 96530.
The Provider submitted the medical records for date of service 3/12/2013. The medical record documented a pump fill and programming. The billed procedure codes 62362 or 62350 do not include the refilling of the implantable pump or reservoir as described in the procedure code 96530. The procedure code 96530 is not incidental or included in the allowance of 62362. The denial of 96530 by the Claims Administrator was not correct.
The electronic analysis and programming of the implanted pump billed under the procedure code 62368 is included in the billed procedure code 62362. The billed procedure code 62362 includes the preparation of the pump with or without programming. The denial of the billed procedure code 62362 by the Claims Administrator was correct.
There is no additional reimbursement warranted for the Official Medical Fee Schedule code 62362.
The additional reimbursement of $47.05 is warranted per the Official Medical Fee Schedule code 96530.
