# New pump reprogramming/refill codes



## karras (Mar 13, 2012)

62370 states it requires a physician's skill to perform the pump reprogramming and refill but does it mean that everytime the physician chooses to do it himself it requires his skill?  The notes do not indicate any complications or reasons as to why the physician chose to perform this himself.  Please help!


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## dwaldman (Mar 13, 2012)

I personally would not ask for additional documentation why he is filling versus him electing to have a non-physician practioner refill it. Below is from CPT Changes 2012 where they describe physician skill.  I feel the physician is responsible for the patient and if he is going to refill the pump (regardless of difficult access or medical issues) then that his management decision.


Clinical Example (62369)
A 65-year-old male has prostate cancer and metastases to multiple bone sites in the lowerbody and resultant bilateral leg and pelvic bone pain. A permanent implantable subcutaneous programmable infusion pump and an intrathecal infusion catheter were implanted for a long-term intrathecal infusion of narcotic. Because of inadequate pain control, the patient now presents for refill and reprogramming of his pump, not requiring physician's skill.
Description of Procedure (62369)
The nurse fills the pump under physician supervision and then electronic analysis is performed to determine reservoir status, alarm status, and the drug prescription status. Electronic analysis of the pump function verifies the infusion rate. Based on the patient's evaluation, the pump is then reprogrammed to adjust the rate of infusion and control the increased level of pain. The pump alarm settings and reservoir levels are programmed as well as any changes made to the drug infusion concentration or mixture. Refill date estimates are also made.
Clinical Example (62370)
A 65-year-old male has prostate cancer and metastases to multiple bone sites in the lower body and resultant bilateral leg and pelvic bone pain. A permanent implantable subcutaneous programmable infusion pump and an intrathecal infusion catheter were implanted for a long-term intrathecal infusion of narcotic. Because of inadequate pain control the patient now presents for refill (requiring physician's skill because of difficult access or other medical issues or complex reprogramming of his pump).
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 and probed to find the actual center of the pump reservoir and advanced through the injection septum of the pump into the reservoir to the proper depth. The residual volume of the solution is aspirated from the pump/reservoir and is measured and checked against the medical records 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/reservoir are then checked for any possible error in administration. The pump is then reprogrammed to adjust the rate of infusion and control the increased level of pain. The pump alarm settings and reservoir 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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## dwaldman (Mar 13, 2012)

The more I thought about your question it is valid question does the documentation have to have an indication why physician skill was required. Since I have billed for a physician always performing it I never considered this documentation element.


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## mhstrauss (Mar 14, 2012)

I've had the same question, and have been unable to find any additional info, other than what dwaldman posted above.  The only examples I've been made aware of here in my clinic (we use these codes for baclofen pumps) are that several of our patients have had weight gain that made needle placement difficult, or the pump had moved out of place or rotated a bit, which of course made needle placement difficult.  In all of these situations, the doctor ended up doing it under fluoro guidance.  I think these are the kinds of things that justify the higher "requiring physician skill" codes...just wish we had more official guidelines to go by 

Hope this helps!


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## karras (Mar 14, 2012)

I was just reading my March issue of the Anesthesia & Pain Coder's Pink Sheet and on page 6 there is an article addressing this issue.  It also references articles from two other pink sheet issues, Nov 2011 and Jan 2012.  I'm not sure I understand it any better after reading the three articles.


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## adamss (Apr 2, 2012)

*62368/62369/62370 confusion*

At our practice we always billed pre Jan 1, 2012 62368 for the pump refill.  We are provider based for their is always the professional billed 62368 and the technical/nurse portion billing for this.  My question is should we not have been billed the 62368 all along since the doctor did not do the pump refill and it was preformed by the nurse, meaning the technical portion we would bill and the professional portion would be a no charge.
 Or was is ok to bill since the phsyican did see the patient, ect....  of course now this falls under 62369.

ALso now as of Jan 1 cpt 62370... does that mean that the physican is the one who needs to do the refill or the nurse does it and he just sees the patient?  anyone have more in depth information on this??


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