The AMA definition of an "other qualified health care professional" below from the definition I could find and excerpt from AMA CPT Changes 2012. If the physician assistant can perform the service in the state you are in and bill under CPT 62370 acting as the "other qualified healthcare professional" then I don't believe in an office setting where the incident to requirements are met that if the service is billed under the physician's NPI that it would revert it back to 62369 if performed by the physician assistant. If a registered nurse performed the reprogramming/refill, then it would have to be under 62369 or the carrier does not recognize the physician assistant to be able to perform and bill under 62370 then 62369 would have to be used if the physician did not perform the refill.
www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf) and the definition is as follows:
“A ‘physician or other qualified health care professional’ is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from ‘clinical staff.’ A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service. Other policies may also affect who may report specified services.”
62370
Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional)
62369
Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill
Clinical Example (62369)
A 65-year-old male has prostate cancer and metastases to multiple bone sites in the lowerbody 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 and reprogramming of his pump, not requiring physician’s skill.
Description of Procedure (62369)
The nurse fills the pump under physician supervision and then electronic analysis is performed to determine reservoir status, alarm status, and the drug prescription status. Electronic analysis of the pump function verifies the infusion rate. Based on the patient’s evaluation, 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.
Clinical Example (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).
Description of Procedure (62370)
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.
