Neurology & Pain Management Coding Alert

Question: What code should I report when our physician analyzes a patient's implantable/programmable pump but does not refill it?

Wisconsin Subscriber

Answer: The correct code depends on the type of maintenance your provider completes and the pump's use.

If he only analyzes the settings for an implantable pump used for intrathecal or epidural drug infusion (to make sure it is functioning properly, or to make sure it is at the correct setting and that the alarm is calibrated, etc.), report 62367 (Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion [includes evaluation of reservoir status, alarm status, drug prescription status]; without reprogramming).

If, on the other hand, your physician analyzes the pump and reprograms the pump to affect the rate of drug delivery, report 62368 (... with reprogramming).

Other pump situation: If your physician deals with an implantable infusion pump for spinal or brain drug therapy, report 95990 (Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal [intrathecal, epidural] or brain [intraventricular]) or 95991 (... administered by physician). You can report these codes with 62367 and 62368 in some situations, but they don't apply to your situation because you-re only coding for maintenance, not refilling.