# Coding of "flipped pain pump"



## celcano (Aug 6, 2015)

I am not sure how this should be coded.  Any suggestions would be greatly appreciated.

Beside having the "flipped pain pump", the patient also had a hernia that was being repaired by another physician at the same time.  Here is Procedure in Detail from my physician:

"An informed consent was obtained.  A peripheral IV was established.  The patient was given prophylactic antibiotics within 60 minutes of the procedure.  The patient was taken to the procedure room where the patient was positively identified by the staff at the attending physician.  The patient was positioned supine on the procedure bed.  Vital signs were monitored as above and remained stable throughout the procedure.  The skin was prepped and draped in the standard sterile fashion.  A time-out was observed and was agreed upon by the members of the team

Incision was made by Dr. A for the hernia repair adn right side of of the abdomen at the place of pain pump, dissection was carried with bovie, hemostasis was achieved, Then, I irrigated the pocket with bacitracin and saline, the pump was freely moving, intact, the old sutures were broken, and the pump was not anchored over the fascia, Ethibond 2.0 was used and 3 sides of the pump was anchored to the fascial of the abdominal muscles. 
Pain pump was refilled with huber needle, 20 ml of dilaudid 1mg/ml injected after aspirating the remaining of hydromorphone from the pump. Dye study was performed, CSF was aspirated from the access port, then 2 ml omnipaq 240 mg/dl was injected, it showed excellent spread of dye into the intrathecal space with no extravasation of contrast. the catheter was intact. Then the subcutaneous tissue over the pump was closed with vicryl 1.0 and the skin was closed with staples.  The rest of procedure was performed by Dr. Ai and Dr. B."

Again, thank you for your assistance.


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## dwaldman (Aug 7, 2015)

Revising the intrathecal pain pump reservoir would fall under an unlisted code. The reprogramming of the pump does is not described in the note, which would exclude  reporting CPT 62370 since the code descriptor describes reprogramming. There is a code CPT 95991 for pump refill without reprogramming. There are also codes such as 61070 75809 that are recognized for catheter dye studies. 

AMA CPT Assistant July 2008 page 13

Radiology: Diagnostic Radiology (Diagnostic Imaging), 75809 (Q&A) 

Question: What is the appropriate code to report for implanted pump catheter dye studies? The patient is not getting pain relief, and an intrathecal catheter is evaluated for dislodgement, discontinuity, or kinking. Contrast is injected through the catheter with fluoroscopic guidance to identify a potential problem. 

Answer: It is appropriate to report code 75809, Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation, for the radiologic supervision and interpretation (RSI) portion of such a procedure to evaluate for shunt catheter patency or leakage. This code can be used for evaluation of a variety of similar and related nonvascular shunt catheters and devices and requires the injection of contrast. Occasionally, evaluation for discontinuity is performed using plain radiography or CT imaging, without catheter contrast injection. In such cases, the service should be reported using appropriate radiography or CT codes describing which anatomical areas were imaged (eg, brain, neck, chest, and/or abdomen). 

Implanted pump catheter dye studies typically require an injection component and an RSI component; therefore, it would also be appropriate for the physician performing the injection to report code 61070, Puncture of shunt tubing or reservoir for aspiration or injection procedure, to describe the injection service itself.


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## celcano (Aug 7, 2015)

Thank you for the reply.  I couldn't locate a code for the pump repair and just wanted to be sure we billed with the appropriate code.  I check for a separate report for the refill programming.


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