EM Coding Alert

Question: If a patient has an implantable pump in their spine that the provider refills for drug delivery, can you report this service separately? Or is it part of the overall evaluation and management (E/M) service?

Massachusetts Subscriber

Answer: If there is no record of a physician or other qualified healthcare professional (QHP) present during the refill, report 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed).

If a physician or other QHP performs the refill, you can report 95991 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional) for the service.

More on 95990/95991: Beware reporting either of these codes with the following codes, as CPT^® forbids it:

• 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 refill)
• 62368 (… with reprogramming)
• 62369 (… with reprogramming and refill)
• 62370 (… with reprogramming and refill (requiring skill of a physician or other qualified health care professional).