Neurology & Pain Management Coding Alert

Question: A patient with a history of osteoporosis and multiple compression fractures came to our clinic for a refill of her implanted spinal opioid infusion pump. When meeting with the physician, she complained of slight worsening of pain since her last visit and requested that the dosage be increased. Our physician performed the refill and reprogrammed the pump with a 10% increase in daily dosage. He did not prescribe any medication and did not manage any other medical issues. How should we code this visit? Do we include an E/M code?

Michigan Subscriber

Answer: You should report 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 skill of a physician or other qualified health care professional]) 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. The provider then reprograms the pump to adjust the rate of infusion and control the patient's increased level of pain. He also programs the pump alarm settings and reservoir levels as well as makes any changes to the drug infusion concentration, rate, or mixture services. Finally, he estimates the date when the patient will need a refill.

You do not need to report an E/M code for this scenario. Any E/M-type service your provider performed during the visit is included in the service of 62370.

Refresher: Physicians use implantable infusion pumps to deliver therapeutic levels of drugs to a specific organ or anatomic site for a prolonged period of time. Codes 62367-62370 and codes 95990-95991 all refer to performing "electronic analysis," which is done to determine the reservoir, alarm, and drug prescription statuses. Pay attention to the other details in your provider's notes to determine which code set should be your focus.

Also remember: Do not report 62367-62370 in conjunction with 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular], includes electronic analysis of pump, when performed) or 95991 (... requiring skill of a physician or other qualified health care professional). Codes 95990 and 95991 apply to refilling and maintenance of a reservoir or a non-programmable implanted infusion pump for spinal or brain drug delivery without reprogramming.