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pump replacement

  1. #1
    Question pump replacement
    Exam Training Packages
    Patient has an intrathecal pump. The pump expires. The Dr takes the pt to surgery, removes the old pump; implants a new pump. Per the CCI edits, 62362 is bundled w/ 62365. However, 62365 as column 1 code, allows the use of a modifier w /62362... So does this mean you can, therefore, bill both, using a modifier on 62362? The Dr is doing the work, so should get reimbursed as such... Please help me figure this out. Thanks.

  2. #2
    i mean to say, per cci edits, 62362 is Mutually Exclusive to 62365.

  3. #3
    Default billing CLE
    A patient goes home without having the baby, what would be the CPT code.

  4. #4
    Greater Orlando
    Quote Originally Posted by apena View Post
    A patient goes home without having the baby, what would be the CPT code.
    Is this a new question? If so, please enter as separate (New) thread and include the physician's case note(s).
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  5. #5
    "7. In a replacement, National Correct Coding (NCCI) edits generally do not allow removal of the existing device to be coded with implantation of the new device. When
    a catheter is replaced, NCCI edits bundle codes 62350 and 62351 for catheter placement into code 62355 for catheter removal, although an override is permitted for a
    separate encounter or anatomic site. When a pump is replaced, the edits bundle code 62365 for pump removal into codes 62361 and 62362 for pump implantation with no
    override permitted."

  6. Default
    62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming

    If he is removing an old pump and putting in a new one then you would only bill 62362 since the code description includes the word "replacement". Hope this helps.

  7. #7
    The word "replacement" in the code descriptor does not always mean a removal is included.

    63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver,
    direct or inductive coupling

    63685 also says replacement but in this case per the NCCI policy they give an example of separate reporting for the removal---in this case "replacement" does not include "removal"

    15. CPT codes 61885, 61886, and 63685 describe “insertion or replacement” of cranial or spinal neurostimulator pulse generators or receivers. CPT codes 61888 and 63688 describe “revision or removal” of cranial or spinal neurostimulator pulse generators or receivers. If the same pulse generator is removed and replaced into the same or another skin pocket, the “replacement” CPT code may be reported. The “removal” CPT code is not separately reportable. Similarly, if one pulse generator is removed and replaced with a different pulse generator into the same or another skin pocket, the “replacement” CPT code may be reported. The “removal” CPT code is not separately reportable. The “insertion or replacement” CPT code is separately reportable with a “revision or removal” CPT code only if two separate batteries/generators are changed. For example, if one battery/generator is replaced (e.g., right side) and another is removed (e.g., left side), CPT codes for the “insertion or replacement” and “revision or removal” could be reported together with modifier 59.

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