Anesthesia Coding Alert

Question: I am new to coding pain management (PM) and came across documentation of epidural catheter implantation and pain pump placement. What is a pain pump and how do I code for it?

South Carolina Subscriber

Answer: Pain pumps, also known as intrathecal pump implants, are another option in the interventional PM arsenal typically reserved for stubborn or unmanageable pain. An intrathecal pump releases small doses of medication directly into the area surrounding the spinal cord, which stops the pain signals from reaching the brain.

Based on the documentation, you’d report 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). Had there also been mention of laminectomy, you’d use 62351 (… with laminectomy) instead.

The following pain pump codes represent all phases of this course of treatment:

• 62360 (Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir)
• 62361 (… nonprogrammable pump)
• 62362 (… programmable pump, including preparation of pump, with or without programming)
• 62365 (Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion)
• 62367 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion … without reprogramming or refill)
• 62368 (… with reprogramming)
• 62369 (… with reprogramming and refill)
• 62370 (… with reprogramming and refill (requiring skill of a physician or other qualified health care professional))

Warning: While the pain pumps are very effective, they are more invasive than ESIs and nerve blocks. To avoid problems with coverage, you should check with each individual payer before submitting claims with these codes, as it might want proof that the provider attempted more conservative treatments to manage the patient’s pain before it will pay for a pain pump procedure.

For more information on reporting implantable infusion pumps, see local coverage determination (LCD) article L35112 at www.cms.gov/medicare-coverage-database/view/lcd. aspx?LCDId=35112.