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Pain Pump Replacement???

  1. #1
    Default Pain Pump Replacement???
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    My doctor did an intrathecal pump replacement and re-position with intra-operative programming of the pump.

    I infiltrated the area of the abdomen with 10mL of local anesthetic, bupivicaine 0.5%, then we used an 11 blade and made a transverse incision over the old incision and then I used a sharp and blunt dissection. I was able to expose the pump, then I aspirated from the catheter access port to the pump and that produced free flow of clear CSF. Then I made a sharp and blunt dissection to re-position the pump more anterior so it does not rub over the left ASIS which is one of the patient's main complaints. Then I connected the catheter to the new pump. I secured the pump to the abdominal fascia using 2-1 Tycron, 3 stitches were taken into the abdominal fascia. Then I irrigated all the incisions. I closed the subcutaneous tissue with 2-0 Vicryl followed by 3-0 Vicryl followed by 3-0 Novafil.

    He wants to code 62360, but I'm going more towards 62362 with the re-position being inclusive as he didn't make a different incision to re-position the pump, just deeper in the same pocket. Am I correct in this rational???

    Thank you

  2. Default Pain Pump Replacement???
    Its a programmable pump...correct?

    I would use 62362-52 Reduced services if same pump was used.
    if new pump used 62362.

  3. #3
    Below is provided by Medtronics guide for reimbursement and coding for targeted drug delivery

    "Revision of Pump----- 64999 Unlisted procedures, nervous system"

    "12. Pump revision includes procedures such as reshaping the pocket, relocating the pocket, or opening the pocket to correct a flipped pump or reconnect the catheter, all while
    re-inserting the existing pump without replacing it with a new pump. There is no CPT code specifically defined for pump revision so an unlisted code is used. For Medicare,
    the unlisted code is contractor-priced. Contractors establish the RVUs and the payment amount, usually on an individual basis after review of the procedure report."

    Need to indicate to the physician CPT 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir describes implanting or replacing the device. If the this a programmable pump and there was a replacement that took place of the pump reservoir/battery than CPT 62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming, would support a replaced device for a programmable pump.

    But if this just is a revision of an existing pump, although 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy, includes providing a revision to the catheter, there is currently no CPT for revision of an existing implanted intrathecal pump and as seen above from Medtronics that revision is unlisted.
    Last edited by dwaldman; 09-24-2018 at 10:10 PM.

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