# Reposition of intrathecal pump w/ closure of wound dehiscence



## lcole7465 (Mar 14, 2018)

My doctor has a patient that came into the office for a wound dehiscence. He took to the ASC and ended up re-positioning the pump and closing the wound: I don't think that 62350 applies since it was placed in the abdomen. I'm thinking 62365 and the closure would be inclusive? 

Patient placed in supine position. We prepped the area with chlorhexidine gluconate scrub technique. Ioban was placed on the abdominal area. The area of the pump was infiltrated with lidocaine 2% and bupivicaine .05% equal volume. total of 18mL was infiltrated to the pump. Then I used an #11 blade and made an elliptical  incision over the whole entire area of the pump t remove any necrotic tissue over the skin edges. I exposed the pump and there was no evidence of infection at this point in time. We REMOVED the pump from the pocket and we dissected into the abdominal fascia, so we can reposition the pump in a better place, so it does not cause any skin tightness over the area. We secured the pump with a #1-0 Ethibond sutures, 3 stitches into the abdominal fascia was taken to secure the pump in place in the relocation. Then we irrigated vigorously the incision. We closed the subcutaneous tissue with 2-0 Vicryl and multiple interrupted suture was taken. Then after obtaining complete hemostasis of the wound, we closed hte subcutaneous tissue with 2-0 Vicryl, multiple stitches were taken into the subcutaneous tissue. Then, we took another layer of 3-0 Vicryl continous, then we closed the skin with inverted mattress sutures. Antibiotic ointment was placed and covaderm was placed on the incision. Abdominal binder was placed. 

thanks


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## dwaldman (Mar 24, 2018)

http://www.medtronic.com/content/da...-drug-delivery-commonly-billed-codes-2018.pdf

Revision of Pump----- 64999 Unlisted procedures, nervous system

12. Pump revision includes procedures such as reshaping the pocket, relocating the pocket, or opening the pocket to correct a flipped pump or reconnect the catheter, all while
re-inserting the existing pump without replacing it with a new pump. There is no CPT code specifically defined for pump revision so an unlisted code is used. For Medicare,
the unlisted code is contractor-priced. Contractors establish the RVUs and the payment amount, usually on an individual basis after review of the procedure report. 

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The note provided would not support 62350 in my opinion. 62365 is for removal only. Revision is unlisted per Medtronics as seen above.


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