Take the Sting Out of Intrathecal Therapy
Published on Fri Nov 01, 2002
Implantation and removal of intrathecal pumps for trials and delivery of pain medication require oncology coders to stay alert to differing documentation strategies. When patients undergoing chemotherapy or radiation cannot tolerate oral, transderma or rectal medication due to the side effects of the opioids, "studies have shown that the us of intrathecal narcotics can yield fewer side effects and complications," says Lynne Carr Columbus, DO, of Gulf Coast Pain Management in Palm Harbor, Fla. Coding Guidelines for Intrathecal Administration Intrathecal pain therapy involves the placement of a pain pump directly under the skin. Via an indwelling catheter, the pump directs controlled doses of analgesia directl to the site of action in the spine. CPT 2002 provides the following codes related to the placement and removal of the catheter and pain pump: 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 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir 62361 ... non-programmable pump 62362 ... programmable pump, including preparation of pump, with or without programming 62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion. Catheters and pain pumps are maintained with the following codes: 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 with reprogramming 96530 Refilling and maintenance of implantable pump or reservoir. Documentation and Drug Guidelines Vary by Region The local medical review policy for Regence Blue Cross Blue Shield, Utah's Part B Medicare carrier, states that intrathecal pain therapy may be used for the management of chronic intractable pain, particularly that which is secondary to carcinoma (primary or metastatic), when it is not controlled by less invasive techniques. As with all covered procedures, medical necessity must be established and the treatment must match the diagnosis. Regence's coding guidelines state that when the cause of pain is malignancy, the diagnosis code for the malignancy should be used. Among the covered ICD-9 codes listed in the LMRP are 170.2 (Malignant neoplasm of the vertebral column, excluding sacrum and coccyx), 170.3 (Malignant neoplasm of ribs, sternum, and clavicle), and 171.7 (Malignant neoplasm of trunk, unspecified). In addition to the CPT codes listed previously, Regence's LMRP also lists two reimbursable drug codes: J2270 (Injection, morphine sulfate, up to 10 mg) and J2271 (Injection, morphine sulfate, 100 mg). "These drugs carry special coverage instructions," says Kelly Dennis CPC, EFPM, owner of the consulting firm Perfect Office Solutions in Leesburg, Fla. Dennis says Florida's Part B Medicare [...]
