# New Pump Refill codes/ Reprogrammming 2012



## dwaldman (Nov 6, 2011)

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)


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## colleenohall (Dec 7, 2011)

*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


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## dwaldman (Dec 9, 2011)

http://professional.medtronic.com/pt/neuro/idd/rm-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."


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## jscholler (Dec 15, 2011)

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


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## dwaldman (Dec 20, 2011)

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


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## dwaldman (Dec 20, 2011)

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.


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## jscholler (Dec 21, 2011)

Thank you!


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## ardellt (Jan 3, 2012)

*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.


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## dwaldman (Jan 3, 2012)

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."


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## kimmerham (Jan 17, 2012)

*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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## dwaldman (Jan 17, 2012)

"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."

http://professional.medtronic.com/w...@neuro/documents/documents/idd-2011-codes.pdf

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.


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## BeckyGK (Jan 23, 2012)

*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


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## dwaldman (Jan 24, 2012)

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 

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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."

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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.


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## BeckyGK (Feb 1, 2012)

Thank you that was very helpful.


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