Neurology & Pain Management Coding Alert

Question: When we have a patient come into the office for refill and reprogramming of a pump implant (95991 and 62368), would it be appropriate to bill a low level office visit based on reviewing the patient's history, taking the patient's vitals and reviewing any medication changes? We have a case where only the vitals were taken and the pump refill and reprogramming was done. Normally the doctor will go over any medication changes.

Answer: The answer depends on the whether the physician performs any additional E/M services beyond those associated with the pump refill and reprogramming. The July 2006 CPT Assistant issue included an article that clearly indicated that the physician services associated with refilling and reprogramming an implanted infusion pump, would not support reporting an E/M code, even if the physician needed to increase or change the pump settings. However, if the patient has another unrelated problem which prompts a separately identifiable and significant E/M service for the unrelated problem, then an E/M service with the appropriate modifier can be reported.