# 62370/62369 vs 95991/95990



## AimeeA10 (Aug 11, 2014)

During the typical refill process, the nurse will generate telemetry readings from the implanted pump which are reviewed and documented. The patient then undergoes a refill procedure consisting of a needle placed through the septum of the pump under ultrasound guidance. This is done by either the nurse or the attending physician who is in the room throughout the entire refill and reprogramming process. The pump is aspirated of the appropriate amount of residual medications. This amount is validated by the physician according to the pre-procedure telemetry. This syringe is removed from the refill tubing and a new syringe containing the new medication(s) is attached and the physician himself injects the medication again validated by ultrasound. Following removal of the needle from the pump refill port, a sterile dressing is applied and the pump is reprogrammed to provide updated information as to the new volume contained within the reservoir and, when appropriate, any changes to the dose or delivery method prescribed by the physician.  Patients receive a medication specific to their individualized pain treatment needs. This may be a single drug or an admixture (combination) of more than one compounded medication.  The specific prescription and dosage may or may not change from the prior refill.  However, the volume contained within the pump reservoir must be reprogrammed in order for the pump to perform accurately and safely. (Note: According to Medtronic, the SynchroMed pump should not be refilled without updating the pump settings as this is a programmable pump, not a constant flow infusion pump).

We are currently billing 62369/62370 based on who provided the service (nurse or MD). We are doing this because per the AMA (CPT Assistant July 2006) and Medtronic (who manufactures the pump) the pump cannot be refilled without be reprogrammed. 
We are being told by Medicare however that our billing of reprogramming when there is not a change related to the medication (ie daily dose, concentration, or new medication) is incorrect. They are downcoding our claims to 95990/95991. 

Based on the info I provided, do you agree that we are indeed properly billing 62369/62370? If not, can you supply me with documentation that supports your statements?
Thanks in advance!


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## dwaldman (Aug 11, 2014)

Below is from AMA CPT Assistant 2012 where they compare the current codes versus the AMA CPT Assistant article they published in 2006. In their, "How to Code" section of the article. It is described as such:

"....The pump alarm settings and reservoir levels are programmed..."

But each of the examples describes that the AMA use have in their examples reprogramming to the drug rate or dose it appears.

I agree that the there are other functions that need to be programmed following refill that do not involve the increase or decrease to the rate or dose, but I was unable to find an example of AMA providing this.

You can purchase a question from the AMA and get a formal response that you could work with the carrier on this gray area. The link below is for the AMA CPT Network which without a subscription initially they will let you purchase a single question. And maybe someone else on the forum will have something that you can use with this appeal

http://www.ama-assn.org/ama/pub/phy...coding-billing-insurance/cpt/cpt-network.page


August 2012 page 10

CPT Assistant Then and Now: Implanted Infusion Pump Refill/Reprogramming


Implantable infusion pumps are used to deliver therapeutic levels of drugs to a target organ or body compartment (site specific) for a prolonged period of time. Codes 62367-62370 and codes 95990-95991 all reference performance of "electronic analysis," which is performed to determine reservoir, alarm, and drug prescription statuses. When electronic analysis of the implanted pump device indicates a satisfactory infusion rate and residual volume, no reprogramming (eg, to change drug rate or dose) or refill is needed. 

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. 

How to Code

CPT code 62370 is reported by the physician when the skill of the physician is required to perform the electronic analysis, sterile aspiration and measurement of the residual volume of solution, and refill, via Huber needle, into the pump reservoir septum. 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, rate, or mixture services. Refill date estimates are also made. No E/M code is reported for this scenario. 


July 2012 AMA CPT Assistant

Code 62368 is reported when electronic analysis is performed to determine reservoir status, alarm status, and the drug prescription status and reprogramming of the device occurs. The electronic analysis of the pump function verifies the infusion rate for which the pump is then reprogrammed (eg, to increase the rate of infusion and control the increased level of pain).

AMA CPT Changes 2012

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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## AimeeA10 (Aug 12, 2014)

Thank you for your response. We will definitely look into the AMA question as we are hoping to have solid guidance from someone to use to appeal our claims with the payer.


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