Pump refills - Does anyone have any helpful tips

lkoch829

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Does anyone have any helpful tips regarding billing for pump refills? Including drug codes, any other HCPCS, E/M rules? I've been given some information that involves billing for the drug and service, plus billing for an e/m + prolonged services codes and I'm not entirely sure how to approach this. I would just love input and any information I could research.

Thank you.
 

tadavis

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Hi
My name is Toni and I work in pain management so I do pump refills all the time. Until I figured out why my reimbursements for the drug codes were so low I was sooo confused
for pump refills I code 62368,95970,A4220, and the drug codes (for the Dr. I use 95971 instead of 95970)--only thing with the drug codes are you have to make sure the pharmacy filling your rx is using the correct measurement per unit for the drugs as the insurance company; (Example fentanyl J3010 measures in MG not MCG ). this will make a hugh difference in the reimbursement. Your pharmacy should be glad to assist you and will change the billing units also.
You can go on line to the different insurance companies and pull up the drugs in the physician fee schedule and most of them will show the measurements per unit.

I hope this helps
 
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codegirl0422

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I would search CMS's website. There is numerous information of this. I will try to find some of the links for you.
 

Walker22

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Hi
My name is Toni and I work in pain management so I do pump refills all the time. Until I figured out why my reimbursements for the drug codes were so low I was sooo confused
for pump refills I code 62368,95970,A4220, and the drug codes (for the Dr. I use 95971 instead of 95970)--only thing with the drug codes are you have to make sure the pharmacy filling your rx is using the correct measurement per unit for the drugs as the insurance company; (Example fentanyl J3010 measures in MG not MCG ). this will make a hugh difference in the reimbursement. Your pharmacy should be glad to assist you and will change the billing units also.
You can go on line to the different insurance companies and pull up the drugs in the physician fee schedule and most of them will show the measurements per unit.

I hope this helps
I hate to disagree with you, but 95970 and 95971 are for programming of Neurostimulator devices, not Implantable Pumps. You should be using 95990 and 95991 instead. 62367/8 is good. I find that a lot of payers, especially Medicare, prefer that you use J3490 (with a description) for the meds. They will then request an invoice which you can submit for reimbursement.
 
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