Neurosurgery Coding Alert

Question: How should I report administration of intrathecal baclofen?

Arizona Subscriber  
Answer: Intrathecal baclofen is administered via an implantable pain pump, which consists of the pump itself, a catheter and an access port. Implantation of the pump and catheter is reported separately. Catheter placement is coded 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, implantation is reported with one of three codes. A programmable pump, which automatically controls dosage, is coded 62362 (implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming). A non-programmable pump is coded 62631. Code 62360 identifies a simple subcutaneous reservoir.
 
Because the pump and catheter are implanted during the same operative session, modifier -51 (multiple procedures) should be appended to the lesser-paying procedure for those payers that require it. If the pump and catheter are implanted during the 90-day global period of a previous, related surgery, both should be reported with modifier -78 (return to the operating room for a related procedure during the postoperative period) appended. If the pumps are implanted during the global period of an unrelated procedure, append modifier -79 (unrelated procedure or service by the same physician during the postoperative period).
 
Pain pumps are refilled through a self-sealing rubber septum. A needle is inserted through the skin and through the septum to replenish the drug supply. To report this service, use 96530 (refilling and maintenance of implantable pump or reservoir) with the appropriate HCPCS J code for the baclofen (J0475, injection, baclofen, 10 mg). Reprogramming of programmable pumps (to adjust dosage) is reported with 62368 (electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [including evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming). Electronic analysis of the pump without reprogramming is reported with 62367.