Doctor wanting bill 62370 everytime pump is refilled

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What documentation is needed to bill 62370? What is needed to support reprogramming the pump everytime it is filled?
 

dwaldman

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I had written the AMA and stated that a reprogrammable pump requires reprogramming such as updating the estimated refill date and the pump contents even when the rate/dosage is not increased or decreased. And asked if they agreed that it is confirmed there is reprogramming of certain aspects of the pump during a refill. They provide examples of previous AMA CPT Assistant article they only describe reprogramming of the drug rate/dose. Examples of those are seen below. Medtronics used to have a statement that reprogrammable pumps require reprogramming at the time of refill. But it appears this statement is no longer in the PDF. I have seen where other practices have mentioned on here they had a certain Medicare contractor saying the drug rate/dose increase/decrease was their definition of reprogramming, but there are clearly other factors that have to be reprogrammed in order for the patients pump to have the necessary information updated. AMA points out that third party payers might have separate interpretations and I think that has to be taken in to account, but I have never seen a payers published interpretation or further insight into reprogramming of the pump setting at the time of refill beyond rate/dose changes

http://professional.medtronic.com/pt/neuro/idd/rm-pm/index.htm#.WHrf_YWcHIU



_________________________________________________________

AMA CPT Assistant 2012

Because CPT coding guidelines may differ from third-party
payer guidelines, eligibility for payment and coverage policy
are determined by each individual insurer or third-party
payer. For reimbursement or third-party payer policy issues,
please contact your local third-party payer.


Implantable infusion pumps are used to deliver therapeutic
levels of drugs to a target organ or body compartment (site
specific) for a prolonged period of time. Codes 62367-62370
and codes 95990-95991 all reference performance of “electronic
analysis,” which is performed to determine reservoir,
alarm, and drug prescription statuses. When electronic
analysis of the implanted pump device indicates a satisfactory
infusion rate and residual volume, no reprogramming
(eg, to change drug rate or dose) or refill is needed.

Clinical Scenario 3
A patient with a history of osteoporosis and multiple compression
fractures presents to the clinic for a refill of her
implanted spinal opioid delivery system. She meets with
the physician, complains of slight worsening of pain since
her last visit, and requests that the dosage be increased.
The physician performs the refill and reprograms the pump
with a 10% increase in daily dosage. The physician does
not prescribe any medication and does not manage any
other medical issues.
How to Code
CPT code 62370 is reported by the physician when the
skill of the physician is required to perform the electronic
analysis, sterile aspiration and measurement of the residual
volume of solution, and refill, via Huber needle, into the
pump reservoir septum. The pump is then reprogrammed
to adjust the rate of infusion and control the increased
level of pain. The pump alarm settings and reservoir levels
are programmed as well as any changes made to the drug
infusion concentration, rate, or mixture services. Refill
date estimates are also made. No E/M code is reported for
this scenario.
Clinical Scenario 6
A patient presents for pump interrogation following a
magnetic resonance imaging of the brain ordered by her
primary care physician. The pump is interrogated by the
practice’s physician assistant (PA) and found to have no
changes from the previous settings. No adjustments are
made to the pump dosage. No physician is present in
the office.
How to Code
Code 62367 should be reported for the pump analysis
without refill or reprogramming. When determining the
appropriate code designated for either the physician or
other qualified health care professional, or designated for
reporting the supervision of clinical staff services, it is
important to note that, as defined in the Introduction
to the Use of the CPT Codebook, “Any procedure or
service in any section of the CPT code set may be used
to designate the services rendered by any qualified physician
or other qualified health care professional or entity
(eg, hospital, clinical laboratory, home health agency).”
The independent reporting of code 62370 by a qualified
health care professional who is qualified by education,
training, licensure/regulation (when applicable), and
facility privileging (when applicable) within his/her scope
of practice, is a third-party payer coverage determination.

AMA CPT Changes 2012 Viganette

62370

A 65-year-old male has prostate cancer and metastases to multiple bone sites in the lower body and resultant bilateral leg and pelvic bone pain. A permanent implantable subcutaneous programmable infusion pump and an intrathecal infusion catheter were implanted for a long-term intrathecal infusion of narcotic. Because of inadequate pain control the patient now presents for refill (requiring physician's skill because of difficult access or other medical issues or complex reprogramming of his pump).

includes a review of patient medical chart with special attention to patient's response to drug delivery via implanted infusion pump. The solution to be injected into the pump/reservoir is ordered by the physician.

Electronic analysis is performed to determine reservoir status, alarm status, drug prescription status. The subcutaneous pump is palpated and identified. The entire area over the pump is prepped and draped. Throughout all this procedure, sterile technique is meticulous to prevent infection. A pump refill kit is then opened and extra required supplies added to the kit

The solution's container is checked to be sure that the drug, the drug volume, and the drug's concentration are all correct according to what was ordered. Using sterile technique, the drug to be injected into the pump is then drawn from its transport vial into a sterile syringe using a filter needle.

The syringe is then connected to a Huber needle with an extension tube in the kit. The needle is advanced and probed to find the actual center of the pump reservoir and advanced through the injection septum of the pump into the reservoir to the proper depth. The residual volume of the solution is aspirated from the pump/reservoir and is measured and checked against the medical records and/or pump status printout to make sure the entire volume of the pump/reservoir has been removed. The syringe containing the new solution attached to the tubing and then very slowly injected into the pump/reservoir. The patient is examined and pump/reservoir are then checked for any possible error in administration. The pump is then reprogrammed to adjust the rate of infusion and control the increased level of pain. The pump alarm settings and reservoir levels are programmed as well as any changes made to the drug infusion concentration or mixture. Refill date estimates are also made.


Communication with the patient, family, and other health care professionals (including written and telephone reports and orders) on the day of the analysis and reprogramming are considered part of the postoperative work for this procedure as well as a follow-up phone call to the patient.
 
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