# Ultrasound code for pump refill???



## HBROCKMAN (Aug 22, 2013)

First things first...can you do a pump refill under ultrasound??  My physicians want to know what CPT to use if they use ultrasonic guidance to locate a pump reservoir...before the rules changed for 76942, we would have used this...but since then we are not clear if it should still be 76942 or 76999 or something else...??  For the same procedure would 77002 be used if fluoro was used to locate the reservoir?? 

Thank you,
Heather


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## johnmeyer (Aug 24, 2013)

I'd be interested to know from a professional stand point. I've never coded a pump refill using any kind of guidance. Our PM doc never seems to use it. If he does, he never puts it in his notes and he's really good about making sure his notes are complete.


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## dwaldman (Aug 27, 2013)

AMA CPT Network response I received. I was looking 76000 versus 77002. Not sure on the ultrasound, but I would say it would support needle guided procedure just would be the carrier's coverage that would need to be considered.

"CPT code 77002, Fluoroscopic guidance for needle placement (eg, biopsy aspiration, injection, localization device), is used to report fluoroscopic guidance during injection procedures when fluoroscopic guidance is required in the performance of needle placement in areas other than the spine, for pain management injection procedures. The organ or anatomic site is not specified for use of code 77002. Codes 76000, Fluoroscopy (separate procedure), up to one hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy), differs from code 77002, in that the descriptor does not specifically identify fluoroscopic guidance for a procedure involving needle or device placement. Please note, from a CPT coding perspective, reporting a radiologic guidance procedure code, including codes 76000 and 77002, requires a separate distinctly identifiable report, or documentation within the report for the procedure where guidance was used, and should be signed by the interpreting physician, as indicated in the Radiology Guidelines. Therefore, in response to your specific question, it would be appropriate to report code 77002, when needle placement utilizing fluoroscopic guidance is performed with code 62370, Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring physician's skill)."


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## johnmeyer (Sep 1, 2013)

I've coded a pump refill under fluoro guidance using 77002, but again, never have using ultrasound guidance.


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## suemt (Sep 4, 2013)

This is great info, but I have a question.  

I have a physician that is also doing refills with guidance.  The Radiology Guidelines I see say "A written report signed by the interpreting physician should be considered an integral part of the radiologic procedure or interpretation."  

Does this mean you would expect all these report components to be included?  

•	Identify patient
•	Identify ordering/referring physician 
•	Identify imaging performed, including any additional facets, contrast, etc.
•	Clinical indication (reason for study)
•	What was done? (number of views/sequences, positioning) 
•	Description of findings
•	Impression/conclusion (synopsis of findings)
•	Reading physician signature

Or would it be sufficient to just mention that guidance was used within the procedure notes?  In particular, would you expect documentation about the reason for needing guidance (since as another poster mentions, the refill kits make it pretty easy to determine where to inject the refill materials)?     




dwaldman said:


> ... Please note, from a CPT coding perspective, reporting a radiologic guidance procedure code, including codes 76000 and 77002, requires a separate distinctly identifiable report, or documentation within the report for the procedure where guidance was used, and should be signed by the interpreting physician, as indicated in the Radiology Guidelines. ...


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## dwaldman (Sep 5, 2013)

Identify patient
• Identify ordering/referring physician 
• Identify imaging performed, including any additional facets, contrast, etc.
• Clinical indication (reason for study)
• What was done? (number of views/sequences, positioning) 
• Description of findings
• Impression/conclusion (synopsis of findings)
• Reading physician signature


I would believe the above information would be found in addition to or within the procedure note. 

Identification of the patient is going to have to be there.
Referring physician is common with EHR... or can be dictated
Identfying imaging performed with contrast noted I would believe would be met in note
Clinical indication----This would be conservative therapy tried and failed. Patient's condtion
Number of views---would be in the procedure note
Description of findings---Would be in procedure note
Impression/conclusion----In procedure note or comments of plan
Reading physician---would be the attending

I not trying to sound redundant with the above but I think what is being said needs to be documented is commonly already there.


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