# SCS and pumps



## pajohnson (Nov 26, 2014)

Just wanted to clarify the difference between these 2 pain therapy devices.

 For *SCS* the implant is usually placed in the *back *area and the  anesthesia code would be 01936 for implantation and revision. For removal you would use 00400 as long as it was not done via laminotomy.   

For *Pain Pumps *the implant is usually placed in the *abdomen* and you would use anesthesia code 01936 for implantation, revision, or repositioning. For replacment and removal you would use 00300.  For drug refill 62367 or 62368.

Also the programmable vs nonprogrammable, does it make a difference on where the pump is placed in the abdomen or back?

Could someone please tell me if I have this correct?  If not, could you please explain where I am incorrect.


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## mhstrauss (Nov 26, 2014)

pajohnson said:


> Just wanted to clarify the difference between these 2 pain therapy devices.
> 
> For *SCS* the implant is usually placed in the *back *area and the  anesthesia code would be 01936 for implantation and revision. For removal you would use 00400 as long as it was not done via laminotomy.
> 
> ...



Patricia,

Here is a good explanation of programmable vs non-programmable pumps; location isn't a factor.

I don't deal with anesthesia, so I can't comment on your questions regarding that, but for the pump refill codes, you would use 62369/62370. The 2 you listed above are for analysis only and analysis with reprogramming

Hope that helps some!

"Implantable Infusion Pumps

Implantable infusion pump use for the delivery of intrathecal (intraspinal) opiates is based on the existence of opioid (narcotic) receptors on the spinal cord to achieve "selective spinal analgesia" (pain relief). Pumps provide for the long-term delivery of opioid (narcotic) medication in the management of malignant (cancer) pain and nonmalignant (non-cancer) pain. Examples of appropriate nonmalignant pain syndromes which may be treated with implantable pumps include "failed back surgery", chronic arachnoiditis, visceral pain syndromes, post herpetic neuralgia, phantom limb pain, spinal cord injuries, peripheral neuropathies and reflex sympathetic dystrophy. A successful temporary trial of spinal opiates is required both to evaluate analgesic responsiveness and to increase the long-term success of the procedure. Individuals must be closely monitored as conversion from high dose oral or systemic opioids to spinally administered opioids will sometimes result in withdrawal symptoms.

Treatment with this therapy should remain a last resort, used only after all other appropriate therapies have failed. A permanently implantable drug-infusion system is not usually appropriate when life expectancy is three months or less; for such individuals, external drug infusion systems can appropriately provide spinal analgesia and comparable pain relief.

The implantable infusion pump (IIP) is a drug delivery system that provides continuous infusion of an agent at a constant and precise rate. The purpose of an IIP is to deliver therapeutic levels of a drug directly to a target organ or compartment. It is frequently used to deliver chemotherapy directly to the hepatic artery or superior vena cava.

An IIP is surgically placed in a subcutaneous pocket under the infraclavicular fossa or in the abdominal wall and a catheter is threaded into the desired position. A drug is infused over an extended period of time. The drug reservoir may be refilled as needed by an external needle injection through a self-sealing septum in the IIP. Bacteriostatic water or physiological saline is often used to dilute therapeutic drugs. A heparinized saline solution may also be used during an interruption of drug therapy to maintain catheter patency.

There is a range of totally implanted catheters with implanted reservoirs and manual pumps as well as totally implanted catheters with implanted infusion pumps. Implantable infusion pumps are available in either programmable or non-programmable models, depending on the type of medication delivery required. Programmable pumps are for flexible medication delivery as dose titration and regulation will vary due to the dynamic nature of the individual. Programmable designs facilitate flexible dosing options and precise dose titration over time.

An example of a flexible medication delivery pump is the SynchroMed? electronic pump, manufactured by Medtronic Inc. (Minneapolis, MN, USA). This pump contains a collapsible reservoir that can be filled with 10 to 18 ml of liquid medication and a peristaltic pump that pushes the medication through a bacteriostatic filter and catheter into the spinal canal. The SyncroMed II Infusion system (implanted after July 2004) is indicated to deliver prescribed medication for the treatment of chronic pain, severe chronic pain and severe spasticity, respectively. The infusion system has a battery life of 5-7 years with a maximum shut-down design to ensure that the pump provides proper administration of intrathecal therapy. The pump has a built in elective replacement indicator (ERI), this alarm sounds when the pump is nearing the end of service (EOS). The pump will no longer operate 90 days after the alarm has sounded, a pump replacement is recommended to avoid interruption in service and risk of withdrawal of baclofen. The U. S. Food and Drug Administration (FDA) issued a Class I recall in September 2011 due to the potential for reduction of battery performance in the SyncroMed II pump. Codman & Shurtleff, Inc. (Raynham, MA), manufacturer of Medstream? Programmable Infusion System received FDA premarket supplement for the implantable infusion pump and catheter system for use with baclofen in the treatment of severe spasticity."

It is from this site:

http://www.anthem.com/medicalpolicies/policies/mp_pw_a053366.htm


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## Amy Pritchett (Dec 2, 2014)

Your codes are correct (as you described in your post). 

Hope this helps


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## dwaldman (Dec 2, 2014)

The anesthesia codes I use for the question you provided, ( please note I agree with the other responses you received) :

SCS Trial---01936
SCS lead and IPG placement---I use 00300----My understanding is this is  that the placement of the internal pulse generator is at the posterior trunk. 

For SCS removal Lead/IPG---I use 00300 because of the location of posterior trunk previous placement

For Pump implant---I use 00400
For pump removal---I use 00400

For pump refill with analysis/ reprogramming performed by physician or other qualified health professional---use 62370----if performed by non-physician personnel---use 62369

For pump refill with analysis without reprogramming, see 95900 for non-physician personnel and 95991 for physician or qualified health professional

For analysis only of the pump , see CPT 62367 
For analysis/reprogramming of the pump, see CPT 62368

I am not sure what the below statement is referring to:

____Also the programmable vs nonprogrammable, does it make a difference on where the pump is placed in the abdomen or back?_____


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## pajohnson (Dec 8, 2014)

*Canpc*

Thank you for all your responses.  I am sitting for the CANPC exam this weekend and I wanted to be sure that I had those clearly defined before taking the exam.  So, wich me luck and pray that I pass.

Thanks again,


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## mhstrauss (Dec 30, 2014)

pajohnson said:


> Thank you for all your responses.  I am sitting for the CANPC exam this weekend and I wanted to be sure that I had those clearly defined before taking the exam.  So, wich me luck and pray that I pass.
> 
> Thanks again,



Any luck on the test? A coworker of mine will be sitting for the CANPC soon.


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## SDALE (Jun 3, 2016)

*sdale, cpc*



mhstrauss said:


> Patricia,
> 
> Here is a good explanation of programmable vs non-programmable pumps; location isn't a factor.
> 
> ...




This is the first time I have used the forum so I am hoping that this works   In the above post you speak of an external pump.  I have a patient that had an internal baclofen pump that got infected and had to have an external pump for a period of time.  So we billed 96521 for maintenance of this pump at the hospital.  I am now reading that you cannot charge this in a facility setting and it is being denied as "incidental to".  Any advice for what the doctor should charge for daily seeing this patient and checking this external pump?


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## marvelh (Jun 19, 2016)

I would look at the Subsequent hospital care E/M codes 99231-99233


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## marvelh (Jun 19, 2016)

or the 01996 _Daily hospital management of epidural or subarachnoid continuous drug administration _ code


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