Neurosurgery Coding Alert

Although pain pumps can alleviate a patient's postsurgical discomfort, some insurers consider them a "last-ditch" treatment to be used only after other pain-control methods have failed.

To meet stringent payer requirements and be reimbursed for implanting and maintaining a pain pump, neurosurgeons must not only supply the proper CPT codes but also carefully document medical necessity and patient history. Surgical Implantation A pain pump consists of several parts, three of which the pump itself, a catheter and an access port are surgically implanted under the patient's skin. The pump is a metal disk about an inch thick and three inches around, which stores and releases medication to treat chronic pain via the catheter to the prescribed location. The access port allows the physician to bypass the pump and access the catheter directly to administer medications or sterile solutions. Implantation of the pump and catheter are reported separately, says Kee D. Kim, MD, associate professor of neurosurgery at University of California, Davis in Sacramento. Catheter placement is coded either 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) or 62351 ( with laminectomy) as appropriate. Depending on the type of pump, surgical implantation is reported using one of three codes. A programmable pump (described above) is coded 62362 (Implantation or placement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming). A non-programmable pump is coded 62361, while a simple subcutaneous reservoir is reported using 62360. Because the pump and catheter are implanted during the same operative session, modifier -51 (Multiple procedures) should be appended to the lesser-paying procedure, Kim says. Note: Depending on the circumstances, either the catheter or pump placement may be the higher-paying procedure. The relative value units (RVUs) for each procedure are: 62350, 11.2 RVUs; 62351, 18.28 RVUs; 62360, 4.78 RVUs; 62361, 9.3 RVUs; 62362, 11.91 RVUs. And, if the pump and catheter are implanted during the 90-day global period of a previous surgery (as is often the case), both procedures should be reported with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended. Note: For more information on modifier -78 and related modifiers -58 (Staged or related procedure or service by the same physician during the postoperative period) and -79 (Unrelated procedure or service by the same physician during the postoperative period) see Neurosurgery Coding Alert, November 2001. Supplying the Evidence:Spasticity Prior to placing a pain pump, the surgeon must prove medical necessity and demonstrate that the patient meets payer-mandated criteria. Generally, Kim explains, neurosurgeons will place a pump for one of two reasons: to [...]