Neurology & Pain Management Coding Alert

Question:  Our physician removed an implanted pain pump and catheter from a patient whose pain pump was implanted 9 days ago. When the abdominal wound was opened, some fluid was found in the cavity which was sent for culture. Please advice for the coding of the pain pump removal. Can we also bill for the wound culture? Can we bill for the swab obtained from the wound fluid and sending it for laboratory culture?

Florida Subscriber

Answer: Pain pumps generally are implanted for long-term pain management and often are not removed very frequently. In a rare instance of the patient ceasing to respond to the pain pump, the physician may decide to remove the pain pump and the catheter. However, the catheter or the pump itself may develop a problem and need to be replaced, such as in the setting of postoperative infection.

You may report code 62365 (Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion) for removal of the pump and 62355 (Removal of previously implanted intrathecal or epidural catheter) with modifier 51 (Multiple procedures) for removal of the catheter. 

Note: The procedure carries a 10-day global period, and the pump removal took place before that global period had expired. Therefore, also append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period …) since the procedure is being performed within the global period and wasn’t anticipated.

There is no separate charge for swabbing the wound and sending the sample to the laboratory for culture. You do not report any separate code for this service.