Neurology & Pain Management Coding Alert

Question: I’m having trouble determining the best way to code for programmable pump refills. An old issue of CPT^® Assistant stated that programmable pumps require programming when they are refilled. Based on that information, it seems that any refill of a programmable pump should be billed with one of the codes that includes programming (such as 62369 or 62370). However, I see providers billing 95990 or 95991 for refill and analysis and no programming, even though the pump is definitely programmable. Do programmable pumps require programming at every refill? Or has something changed since that information was published in CPT^® Assistant?

New Mexico Subscriber

Answer: As you have noted, correct coding in this situation will depend on the type of pump used and the specific services provided by the physician.

You have three code possibilities for pumps that can be reprogrammed (whether they are during a particular session or not):

• 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 or refill)
• 62368 (… with reprogramming)
• 62370 (… with reprogramming and refill (requiring skill of a physician or other qualified health care professional))

The other codes you’re questioning are used for non-programmable pumps (constant flow or reservoir):

• 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)
• 95991 (… requiring skill of a physician or other qualified health care professional).