# ultrasound guidance for pump refill ?



## betsycpcp (Aug 6, 2012)

Is it common to do ultrasound guidance with refilling and maintenance of a pain pump?  The codes I am seeing are 95991 and 76942.  The report says "Ultrasound guidance was utilized to identify the access port; the site was subsequently marked."  There's no explanation of why ultrasound guidance was used in this case, and no description of what was seen on ultrasound.  I don't recall seeing this from other providers and wondered if it is standard practice.  

Is it possible that it's done but not separately coded normally?

Thanks


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## hewitt (Aug 6, 2012)

As far as I know, this is not common, but may be appropriate. Have you checked for medical necessity? Do not know what your ICD-9s are, but 76942 has medical necessity issues, and may rule out use of the CPT.


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## betsycpcp (Aug 6, 2012)

The ICD9's are 722.10 and 724.2.

Thanks!


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## dwaldman (Aug 6, 2012)

I would double check if there was reprogramming also performed and documented and then CPT 62370 would be used instead of 95991 (pump refill and analysis). 

I would use 76942 in addition to the pump refill code . If you feel they need to document the indication for the ultrasound guidance. I would present that to them. I am personally seeing the pump refill performed with fluoroscopy which I received a confirmed response from the AMA CPT Network that 77002 would be reported.


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## kdlepek (Aug 8, 2012)

We use 62368 and 95991. We do a ton of pumps and I have never used a guidance code. I have tried the 62370 but some payors don't have the updated code. Unless stated otherwise in the CPT I would consider it a seperate procedure. We use DX 338.4, 724.2, 722.83 on most of the refills.


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## dwaldman (Aug 10, 2012)

kdboyd, I noticed you stated you were using 338.4 Below is from Medtronics PDF describing the difference between 338.29 and 338.4. Just some information to consider for chronic pain versus chroinic pain syndrome.

Pain must be specifically documented as “chronic” to use code 338.29. Similarly, the diagnostic term “chronic pain syndrome” must be specifically documented to assign code 338.4. If these terms are not documented, then other symptom codes for pain may be assigned instead. However, they cannot be sequenced as principal diagnosis. Rather, the underlying condition would ordinarily be used as the principal diagnosis in this circumstance.

I could understand 63268 and 95991 for a work comp carrier that does not update their fee schedule per year and that is the codes that were pre authorized. But for all other carriers I would use 62370 for reprogramming and refill. I don't believe there are carriers out there that are not work comp that don't recognize the 2012 codes by August.


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## dwaldman (Aug 15, 2012)

Below is excert from AMA CPT Assistant 2012, where they describe the use of image guidance for pump refill: 

"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. 

The performance of the services that will potentially require the skill of the physician or other qualified health care professional is reported with terminology that specifies "requiring physician skill." The use of these higher skill codes is typically associated with patients for whom access is difficult or painful due to presence of scar tissue or myofascial or other disease in the same area as the port. If intravenous sedation or fluoroscopy is needed to adequately identify the pump and refill port and/or use of instrumentation is needed to find and hold the pump in place, these would be aspects of patient care that would typically require the skill and knowledge of a physician."


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