Wiki Repositioning of subq intrathecal programmable pump

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dchagy

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Need you help finding a code for the repositioning/revision of subq intratheacal pump. All I can come up with is the unlisted code. This is Medicare and unlisted for ASC facility is a no no.. The physician is repositioning the pump, not replacing. CPT code 62360 is for the implantation or replacement, CPT code 62365 is for the removal. I really need some advice. The patient has been scheduled a week from today. If the unlisted code is appropriate we must request the patient be scheduled in appropriate facility. HELP!
 
(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

[I received you email and will response here]

I do not have experience with this procedure, and someone else may have better insight than I do, but my thinking would be that if your physician is 'repositioning' the pump, then he/she is 'removing' the pump (62365) from its present location and 'implanting' it (62360) in a new location. NCCI edits indicate that 62365 is bundled into 62360 with 'no circumstances in which a modifier would be appropriate'. This leaves you with coding the 'pump repositioning' as 62360. A good indication that this may be the appropriate code is that this code is used also for 'replacing' a pump, which would entail 'removal' and 'implantation', which is quite similar to what your physician is doing.

Richard Mann, your pain management coder
rkmcoder@yahoo.com
 
I did look at these codes but are they appropriate for the repositioning/revision of the device in the subq pocket since no new device will be implanted? He will use the same device. Medicare pays for the device with these codes. Thank you for your speedy answer. You know how it helps to talk things out with someone else and I appreciate your response.
 
(These are my opinions and should not be construed as being the final authority. Other opinions may vary.)

I don't see either of these codes on the Medicare ASC Device Intensive listing, so the device will not automatically be reimbursed. Is the code appropriate? If your physician is merely moving the pump around in the same pocket without removal/re-implantation, then the code probably is not appropriate. If your physician is removing the pump, prepping a new pocket, and re-implanting, then I would be comfortable with the code, but you and your physician need to make that call.

Richard Mann, your pain management coder
rkmcoder@yahoo.com
 
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