Anesthesia Coding Alert

" You should code each phase of intrathecal pump placement differently, and the different phases hold different challenges. But your work coding for pump refills and maintenance will be easier now, thanks to new and revised codes for 2003. Follow Three Steps to Coding Success Intrathecal pump placement is an involved process that includes three distinct phases trial insertion and evaluation, permanent placement, and maintenance/follow-up. The physician uses trial insertion and evaluation to determine whether an implantable pump is the patient's best option. The next step is permanent placement, followed by maintenance. (For a detailed discussion of each step, see the July 2001 Anesthesia and Pain Management Coding Alert.) Cindy Parman, CPC, CPC-H, RRC, principal and co-founder of the consulting firm Coding Strategies Inc. in Dallas, Ga., offers an overview of the process: Step 1: Trial insertion and evaluation The physician can conduct a trial in one of three ways: a single medication injection (often called a single-shot trial), continuous infusion of medication, or insertion of a tunneled catheter with an external pump delivering the medication. The physician's preference and the patient's condition determine the type of trial and its timeframe. Coding for the trial varies according to the method. Appropriate codes include the following:

CPT 62310 (Injection, single [not via indwelling catheter], not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62311 ( lumbar, sacral [caudal]) for single-shot trials

CPT 62318 (Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast [for either localization or epidurography], of diagnostic or therapeutic substance[s] [including anesthetic, antispasmodic, opioid, steroid, other solution], epidural or subarachnoid; cervical or thoracic) or 62319 ( lumbar, sacral [caudal]) for continuous infusion

CPT 62350 (Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy) or 62351 ( with laminectomy) for tunneled catheters. Code CPT 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) is appropriate if the anesthesiologist provides anesthesia for the insertion but doesn't remove the catheter. Step 2: Permanent placement Correct coding for the pump's placement depends on the anesthesiologist's role in implantation, how you coded the initial trial and whether the pump is programmable. Possibilities include 00630 (Anesthesia for procedures in lumbar region; not otherwise specified), 62361 (Implantation or replacement of device for intrathecal or epidural drug infusion; non-programmable pump) and 62362 ( programmable pump, including preparation of pump, with or without programming). You may [...]