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.
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