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New Pump Refill codes/ Reprogrammming 2012

  1. #1
    Default New Pump Refill codes/ Reprogrammming 2012
    Medical Coding Books
    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

    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 physician's skill)

    (Do not report 62367-62370 in conjunction with 95990,95991. For refilling and maintenance of a reservoir or an implantable infusion pump for spinal or brain drug delivery without reprogramming, see 95990, 95991)

  2. Default Difference with 95990??
    Hello,

    I am racking my brain trying to determine the difference between using codes 95990 and 95992 or 62367 - 62370. The only thing I can come up with is that the 95990 and 95992 would be used for NON-REPROGRAMMABLE pumps? Can anyone help? I can't find any guidance anywhere. Thanks!

    Colleen

  3. #3
    Default
    http://professional.medtronic.com/pt...m-pm/index.htm

    The above link, Medtronics has helpful coding references.

    From AMA CPT Changes 2012

    "Code 62367 has been revised to specify that it does not include refilling of a programmable, implanted pump that is used for intrathecal or epidural drug infusion. Codes 62369 and 62370 were added to this code family to report electronic analysis of a programmable, implanted pump for intrathecal or epidural drug infusion, including reprogramming and refilling of the pump. Code 62369 is reported with a physician's skill is not required to perform the service. Code 62370 should be reported when the service does require a physician's skill. Codes 62367-62370 should not be reported with codes 95990 and 95991. Codes 95990 and 95991 should be reported for refilling and maintenance without reprogramming (when performed) on a reservoir or an implantable infusion pump for spinal or brain drug delivery."

  4. Default
    For 62370- which requires physician's skill- would it be appropriate to bill for a CRNP or PA?

  5. #5
    Default
    This pertains to 95900/95991 but the same concept could be applied for 62369/62370

    CPT® Assistant, July 2006, Volume 16, Issue 7 The services for refilling and maintaining implantable delivery systems (infusion pumps or reservoirs) that include intrathecal, intraventricular, and epidural drug delivery are described by codes 95990, Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal(intrathecal, epidural) or brain (intraventricular), and code 95991, Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular); administered by physician. The refill and maintenance of these types of pumps differs from that of systemic infusion in terms of risks, knowledge required, skill required, and severity of potential complications. Hence, codes 95990 and 95991 allow a more specific description, which reflects the work, time, and intensity for the refill and maintenance of pumps providing spinal or brain infusion as opposed to intravenous systemic infusion. Code 95990 has no physician work value and describes the services reported by the nonphysician provider, while code 95991 is reported for the physician services provided in the refilling and maintenance of the implantable pump or reservoir.

    Medicare Part B Bulletin Palmetto GBA: Nov 04 Publish Date November 2004 States Affected OH WV Subject Refilling and Maintenance of Neuraxial Drug Administration Systems ~ Clarification "CPT code 95991 may be submitted for the refilling and maintenance of neuraxial drug administration systems when the physician personally provides the service, or when the service is provided "incident to" under the direct supervision of a physician. The requirements for incident to are detailed in CMS Internet Only Manual (IOM) Pub.100-2 Medicare Benefit Policy, Chapter 15, Sections 60.1-60.3. All physicians providing the service must have training and expertise in this procedure. Physicians with specialty designations 05, 09, 13, 14, 20, 25, and 72 are deemed to have the prerequisite expertise by virtue of their specialty qualifications

  6. #6
    Default
    I also saw this on Supercoder in regards to reporting for the physician assistant.

    Published in Anesthesia Coding Alert, September 2011


    Question: How do we report the service when a physician assistant completes a pump refill?

    Florida Subscriber

    Answer: You should submit 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]). CPT® includes a companion code in 95991 (… administered by a physician), but you'll only report it when the physician completes the refilling and maintenance. Because a physician assistant is a non-physician provider, his or her services don't qualify for 95991.

    Reminder: You can also report 62368 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming) along with the pump refill code. The provider does not need to make a change in the pump drugs and/or administration rate in order to compliantly report the reprogramming code (62368) at the time of the refill.

  7. Default
    Thank you!

  8. #8
    Question NP doing refills
    We have nurse practitioners that do pump analysis, reprogramming and refills, which of the new codes would we use(62369 or 62370). Does anyone know why this code is in two categories? Normally a NP can bill the same codes as a physician.
    Thank you in advance for any info.

  9. #9
    Default
    When the descriptor for 62370 says physician skill----------means the physician is placing the needle into the pump resevoir for example-------if does not require a physician to perform then 62369 would describe the service performed by a non physician provider.

    Below is from AMA CPT Changes 2012

    "Code 62369 is reported when a physician's skill is not required to perform the service. Code 62370 should be reported when the service does require physician skill."

  10. Default Refill of Inf Pump
    Can anyone tell me how they would code this:
    Pt. comes in for a pump refill. The pump was electronically analyzed and remains at the current rate of 290.2mcg/day. The doctor refills the pump, the pump was updated, all alarms were enabled, a copy of the printout was obtained. Successful pump refill.

    Not sure when to use 95990/95991 or 62369/62370? what is the difference between maintenance and reprogramming?

    Thanks.

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