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Neurology & Pain Management Coding Alert

Reader questions:

Reporting 62362? Don't Include 95991

Published on Tue Jan 18, 2011

Question: Medicare denied our claim with 62368 and 95991 for implanting a programmable pump and filling the infusion pump. When I called to ask for information, the representative said we could append a modifier and be paid for both procedures. How should we handle this?Answer: The reason for your denial lies in the code descriptors and CCI (Correct Coding Initiative) edits.Code 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) applies to existing pumps. You coded for a pump implantation, which makes 62368 incorrect. Instead, you should report 62362 (Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming).Look closely at the descriptor and you'll see that the initial implantation service of the infusion pump includes the initial filling, whether the healthcare provider [...]
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