Anesthesia Coding Alert
Watch NCCI Edits for Pump Refills
Question: Medicare denies our claims for reprogramming and refilling an implantable pump, saying that the refill/maintenance code is global. We know that NCCI edits bundle 96530 with 95990, but we're billing 62368 instead. - You Be the Coder and Reader Questions were answered by Eileen Lorenco, RHIT, CS, CPC, with Lahey Clinic in Burlington, Mass.
California Subscriber
Answer: The National Correct Coding Initiative edits bundle many codes associated with pump placement and maintenance. This includes 96530 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic [e.g., intravenous, intra-arterial]), which is bundled with 62368 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; with reprogramming), so you can't report them separately.
If the physician or nurse must refill the pump during the 90-day post-op period, report 62368 with modifier -59 (Distinct procedural service). Some coders report modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) instead of modifier -59, but others say this is not truly a staged procedure that merits -58.
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