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New Pump Refill codes/ Reprogrammming 2012

  1. #11
    Medical Coding Books
    "13. Code 62367 is used for pump interrogation only (e.g., determining the current programming, assessing the device's functions such as battery voltage and settings, and
    retrieving or downloading stored data for review). Code 62368 is used when the pump is both interrogated and reprogrammed. In the context of a refill, the AMA has
    published that pumps require reprogramming at the time of refilling and that it is appropriate to use 62368 for resetting the pump to its original parameters after a refill."

    Above is from the Medtronics, which is a PDF prior to 2012 code changes but describes analysis versus reprogramming. Below is from AMA CPT Changes 2012

    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 through the injection septum of the pump into the reservoir to the proper depth. The residual volue of the solution is aspirated from the pump/reservoir and is measured and checked agaisnt the medical reords 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/resevoir are then checked for any possible error in adminstration. The pump is then reprogrammed to adjust the rate of infusion and control the increased level of pain. The pump alarm settings and servoir levels are programmed as well as any changes made to the drug infusion concentration or mixture. Refill date estimates are also made.

  2. #12
    Grand Canyon Coders
    Question Pump refill and Office visits
    I have physicians that are doing pump reprogramming and refills 62370.
    They are also including an office visit with history, exam and medical decision making with opioid oral drugs they are also prescribing V58.69. They also are prescribing drugs for nausea. The history is related to the pump mostly and only small bit about the other issues. I can only get 99212 out of the visit history and exam, however due to the V58.69 diagnosis the doctor believes he should get nothing lower than 99213. Does anyone know any articles that have information about this I can give my provider? Also do they need to put a lot of info with the pump refills or just that it was reprogrammed and refilled and what went in it? Any examples anywhere would be great. Thank you

  3. #13
    The visit would need to contain 2 of 3 key components for a follow up visit. The underlying condition would be coded and the V code V58.69. Prescription drug management is considered moderate risk . You could work with the provider to show that he is right his medical decision making meets the level 3 that he is suggested he feels the service meets but help provide the code requirements of level 2 versus a level 3 in terms of all of the different 3 components. And it could be determined where in the history or exam the physician might not be aware of for example a ROS requirement in 99213 which is not required in 99212.

    99212 requires a problem focused history (Chief Complaint, HPI (1-3 elements), Problem focused exam (1-5 elements identified by a bullet) and straightforward medical decision making (diagnosis--1 point for stable condtion) Data reviewed (0-1) minimal risk

    99213 requires a expanded focused history (Chief Complaint, HPI (1-3 elements) ROS (1 problem pertinent), Expanded probelm focused exam (6+ elements identified by a bullet) Low medical decision making (diagnosis 2, data reviewed 2, low risk)

    99214 requires a detailed history (Chief Complaint, HPI (4 or more elements) ROS (2-9) PFSH 1 Detailed Exam (2 bullets from 6 areas/systems OR 12 bullets from 2 or more areas/systems Moderate medical decision making Diagnosis (3) Data Reviewd (3) Moderate risk

    __________________________________________________ ________________

    AMA CPT Assistant 2006
    "Some ambiguity arises among the coding community when reporting codes 95990 and 95991 in addition to evaluation and management (E/M) services. It is important to note that the E/M service is not included in codes 95990 and 95991. If a significant, separately identifiable E/M service is performed, the appropriate E/M service code should be reported using modifier 25, Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, in addition to codes 95990 and 95991."

    Clinical Scenario 2

    A patient with a history of complex regional pain syndrome of the right lower extremity presents to the pain clinic for evaluation and refill of his pump. He is seen by the nurse for initial intake. The patient reports decreased libido, increased peripheral edema, and poor pain control. The nurse refills the pump. The physician sees the patient, reprograms the pump, orders laboratory tests to check for drug-induced hypogonadism, and recommends follow-up with the primary care provider for his peripheral edema and laboratory results. In addition, the physician adjusts the patient's oral medications to help with his pain. The physician spends 25 minutes counseling the patient.

    CPT code 95990 is reported for the refill of the pump performed by the nurse. Code 62368 is reported for the reprogramming by the physician. The appropriate level E/M service code is reported with modifier 25 appended for the counseling provided by the physician.

    Clinical Scenario 3

    A patient with a history of osteoporosis and multiple compression fractures presents to the clinic for a refill of her implanted spinal opioid delivery system. She meets with the physician, complains of slight worsening of pain since her last visit, and requests that the dosage be increased. The physician performs the refill and reprograms the pump with a 10% increase in daily dosage. The physician does not prescribe any medication and does not manage any other medical issues.

    CPT code 95991 is reported for the pump refill provided by the physician. Code 62368 is reported for the reprogramming. No E/M code is reported for this scenario."

    __________________________________________________ _______________
    NCCI Policy Manual
    Modifier 25: The CPT Manual defines modifier 25 as a “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service”. Modifier 25 may be appended to an evaluation and management (E&M) CPT code to indicate that the E&M service is significant and separately identifiable from other services reported on the same date of service. The E&M service may be related to the same or different diagnosis as the other procedure(s).
    Modifier 25 may be appended to E&M services reported with minor surgical procedures (global period of 000 or 010 days) or procedures not covered by global surgery rules (global indicator of XXX). Since minor surgical procedures and XXX procedures include pre-procedure, intra-procedure, and post-procedure work inherent in the procedure, the provider should not report an E&M service for this work. Furthermore, Medicare Global Surgery rules prevent the reporting of a separate E&M service for the work associated with the decision to perform a minor surgical procedure whether the patient is a new or established patient.

  4. #14
    Grand Canyon Coders
    Thank you that was very helpful.

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