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Thread: CPT Code 62368

  1. #1

    Default CPT Code 62368

    AAPC: Back to School
    Our doctor performed a implant for a program pump. When I billed for this Medicare is denying the CPT Codes 62368 (analysis program reprogram) and 95991 (refill infusion Pump) saying that they are include in a different procedure but when I call and ask about this. They tell me that I can attach a modifier to these CPT Codes and i can get remibursed for theses CPT Codes. If there is anyone that can help me with this please let me know. Thank You!!

  2. #2
    Join Date
    Apr 2007


    62362 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming

    I used the email function for WPS Medicare and asked them do they consider the PACU-Post Anesthesia Recovery Unit or Recovery area used after a procedure to recovery the patient a "separate encounter" following a procedure. I gave them example of where the physician implanted a intrathecal tunneled catheter and pump resevoir (62350 and 62362), but in the recovery area he performed analysis of the pump (62367). They called me back and said that the recovery area following the procedure is not a separate encounter and that modifier 59 would not be appropriate in this scenario, that it would be included in 62362.

    So for your example, if I understand you correctly, you are trying to bill for 62362 implanation of pump plus refilling 95991 plus 62368 reprogramming.

    Reviewing the descriptor it makes sense that the NCCI edits include 62368 as a column two code, since the descriptor states "with reprogramming" , it would be known that "with" means that "reprogramming" would be inclusive when reporting 62362.

    In Regards, to 95991 "refilling" of the pump. Since it a new pump then it would not require refilling in sense that 95991 is suppose to be reported and 95991 should be reported in addition for initial placement.

    When calling your MAC Medicare carrier, you are potentially only talking to customer service and have to remember that they are giving a broad or general explanation of NCCI edits and it is not necessarily their responsibility to interpret how to code procedures like the one in question when you are calling over the phone and not emailing your question. But when you start snagging NCCI edits with the way you are selecting the code assignment that can give you some insight that you might be additionally listing components of the main procedure that in absent of the NCCI edits would be consider inclusive based AMA or speciality society standards.

  3. #3
    Join Date
    Apr 2007
    Denver Colorado


    Actually the code descriptor "Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming" goes with the 62362 CPT code and that is where the bundling edit occurs.

    The initial implantation service of the infusion pump includes the inital fill and programming as evidenced by the phrase "including preparation of pump (aka fill) and phrase "with or without programming".

    It would not be compliant to report the "refill" and "reprogram" CPT codes when the pump is initially implanted as the reimbursement for the 62362 includes the fill and programming.

    This is the basis for the NCCI bundling edits for 62368 and 95991 being bundled as components of the more comprehensive 62362 code.

  4. #4
    Join Date
    Apr 2007

    Default Can we bill for 62368 for a patient at their home?

    If a patient is elderly and is unable to come to the pain clinic can we do the analysis of their pump with reprogramming at their home and should Medicare or Med-Cal pay for this if we use the right place of service code?


  5. #5
    Join Date
    Apr 2007


    I have a case where physician removes pump & catheter and implanting new pump & catheter in a new separate incision
    62355 removal of previous catheter
    62365 removal of pump
    62350-59 implantation of new catheter
    62362 implantation of new pump
    My question is 62365 in bundled in with 62362 and no modifier is allowed. shouldn't I be able to bill this since it's a new incision site

    Thank You

  6. #6
    Join Date
    Apr 2007


    7.For pump*or*catheter*replacement,*National*Correct*Cod ing*(NCCI)*edits*do*not*allow*removal*of the existing*device*to*be*coded*separately*with*implan tation*of*the*new*device.*


    Above is found on Medtronic's reimbursement guide for the procedure in question.

    Below is contact information for NCCI which you could request further clarification.


    This web page provides information to providers on Medicare's NCCI edits but does not address specific NCCI edits. If the viewer has concerns about specific NCCI edits, he/she may submit comments in writing to:

    National Correct Coding Initiative
    Correct Coding Solutions LLC
    P.O. Box 907
    Carmel, IN 46082-0907

    Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist

    Fax #: 317-571-1745

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