Wiki Baclofen One shot trial and diagnosis issue

[eernspiker]

Hi everyone,

I am in need of help with our baclofen trial one shot cpt code 62311 and a diagnosis code for spastic hemiplegia. We cannot seem to get this paid by the insurance as the cpt code and diagnosis do not support one another. This cpt code is the only one that we can use for the one shot trial and the patient has already tried the oral baclofen medication. Any thoughts, advice, opinions are very much appreciated.

 

[dwaldman]

342.10 - 342.12 SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING UNSPECIFIED SIDE -SPASTIC HEMIPLEGIA AND HEMIPARESIS AFFECTING NONDOMINANT SIDE

Anti-spasmodic drugs administered intrathecally (e.g., baclofen) to treat chronic intractable spasticity are addressed in the Infusion Pump NCD Pub. 100-3 Sec. 280.14. The CPT description of procedure codes 62310, 62311, 62318 and 62319 include anesthetic, antispasmodic, opioid, steroid, other solution; therefore the spasticity conditions are included in this LCD.

Do you not have a statement such as this in the LCD for the Medicare carrier you are billing? Or is it commercial carriers you are having the problem. They might not have these types codes set up in their software and you will have to appeal with explantation of the treatment.